Organization
NE PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT L ROSS MD (PHYSICIAN)
(570) 347-5605
Entity
Organization
Contact information
Practice address
440 N MAIN AVE, SCRANTON, PA 18504-1720
(570) 347-5605
(570) 489-4583
Mailing address
440 N MAIN AVE, SCRANTON, PA 18504-1720
(570) 347-5605
(570) 489-4583
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD009571E
PA
208000000X
Pediatrics Physician
MD063076L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007577660001
—
PA
01
—
361842
BLUE SHIELD
PA
Enumeration date
01/25/2008
Last updated
01/25/2008
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