Organization
PREMIUM PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE OKLOTA-FADELL MD (PRESIDENT)
(330) 652-3100
Entity
Organization
Contact information
Practice address
918 YOUNGSTOWN WARREN RD, SUITE C, NILES, OH 44446-4623
(330) 652-3100
(330) 652-1231
Mailing address
918 YOUNGSTOWN WARREN RD, SUITE C, NILES, OH 44446-4623
(330) 652-3100
(330) 652-1231
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2600760
—
OH
Enumeration date
12/13/2005
Last updated
08/22/2020
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