Provider Demographics
NPI:1104880442
Name:PIKE CREEK PEDIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:PIKE CREEK PEDIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LYNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-239-7755
Mailing Address - Street 1:5500 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1772
Mailing Address - Country:US
Mailing Address - Phone:302-239-7755
Mailing Address - Fax:302-234-2735
Practice Address - Street 1:5500 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1772
Practice Address - Country:US
Practice Address - Phone:302-239-7755
Practice Address - Fax:302-234-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000079502Medicaid