Provider Demographics
NPI:1194810127
Name:PEDIATRIC ASSOCIATES PC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:LERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-861-1611
Mailing Address - Street 1:7600 N 15TH ST
Mailing Address - Street 2:#130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4347
Mailing Address - Country:US
Mailing Address - Phone:602-861-1611
Mailing Address - Fax:602-371-8929
Practice Address - Street 1:7600 N 15TH ST
Practice Address - Street 2:#130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4347
Practice Address - Country:US
Practice Address - Phone:602-861-1611
Practice Address - Fax:602-371-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty