Provider Demographics
NPI:1215339098
Name:RAINBOW PEDIATRICS, INC
Entity type:Organization
Organization Name:RAINBOW PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERNALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-250-0150
Mailing Address - Street 1:1404 ROBERT C. BYRD DR.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-9470
Mailing Address - Country:US
Mailing Address - Phone:304-250-0150
Mailing Address - Fax:304-250-0153
Practice Address - Street 1:354 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8985
Practice Address - Country:US
Practice Address - Phone:304-250-0150
Practice Address - Fax:304-250-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty