Organization
MAIN STREET PEDIATRICS OF GREATER SCRANTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNIE MCDONOUGH (OFFICE MGR.)
(570) 291-4180
Entity
Organization
Contact information
Practice address
247 MAIN ST # PA, DICKSON CITY, PA 18519-1641
(570) 291-4180
(570) 586-3953
Mailing address
247 MAIN ST # PA, DICKSON CITY, PA 18519-1641
(570) 291-4180
(570) 586-3953
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011992910003
—
PA
Enumeration date
06/11/2019
Last updated
06/11/2019
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