Organization
PEDIATRIC & PREVENTIVE MEDICINE ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL TERENCE DRAIN SR. MD (PRESIDENT OWNER)
(215) 227-3300
Entity
Organization
Contact information
Practice address
4035 POWELTON AVE, PHILADELPHIA, PA 19104-2262
(215) 471-7000
(215) 474-0451
Mailing address
3847 NORTH SYDENHAM STREET, PHILADELPHIA, PA 19140
(215) 227-3300
(215) 227-3118
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD039729L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1054660
—
PA
Enumeration date
12/13/2006
Last updated
07/11/2016
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