Organization
UPPER VALLEY PROFESSIONAL CORPORATION
Active
Other names
Pediatric Group
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA RADER (ADMINISTRATOR)
(937) 440-7454
Entity
Organization
Contact information
Practice address
280 LOONEY RD, SUITE 101, PIQUA, OH 45356-4199
(937) 440-8687
(937) 773-8058
Mailing address
PO BOX 479, TROY, OH 45373-0479
(937) 440-8687
(937) 773-8058
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2616404
—
OH
Enumeration date
09/22/2006
Last updated
08/20/2010
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