Organization
JEFFERSON PARK PEDIATRICS P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GIRIDHAR RAO VEERULA MD (OWNER)
(260) 436-7722
Entity
Organization
Contact information
Practice address
3919 W JEFFERSON BLVD STE 1, FORT WAYNE, IN 46804-6811
(260) 436-7722
(260) 459-0012
Mailing address
3919 W JEFFERSON BLVD STE 1, FORT WAYNE, IN 46804-6811
(260) 436-7722
(260) 459-0012
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
202D00000X
Integrative Medicine Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200262620
—
IN
Enumeration date
09/07/2007
Last updated
04/23/2025
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