Provider Demographics
NPI:1285391086
Name:ANDORRA PEDIATRICS LLC
Entity type:Organization
Organization Name:ANDORRA PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-483-8558
Mailing Address - Street 1:8945 RIDGE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2036
Mailing Address - Country:US
Mailing Address - Phone:215-483-8558
Mailing Address - Fax:215-487-1270
Practice Address - Street 1:8945 RIDGE AVE STE 5
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19128-2036
Practice Address - Country:US
Practice Address - Phone:215-483-8558
Practice Address - Fax:215-487-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty