Organization
PANDA BEAR PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARISSA F DOMINY D.O. (PHYSICIAN/MANAGING MEMBER)
(610) 409-8050
Entity
Organization
Contact information
Practice address
555 SOUTH SECOND AVENUE, BUILDING B, SUITE 200, COLLEGEVILLE, PA 19426-2854
(610) 409-8050
(610) 409-8075
Mailing address
102 SHETLAND WAY, COLLEGEVILLE, PA 19426-2854
(610) 409-8050
(610) 409-8075
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS-009162L
PA
Other
Enumeration date
07/07/2006
Last updated
08/22/2020
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