Provider Demographics
NPI:1104085638
Name:PEDIATRIC ASSOCIATES OF HAMPTON & PORTSMOUTH PC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF HAMPTON & PORTSMOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-436-7171
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-436-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty