Provider Demographics
NPI:1285709063
Name:THE CHILDREN'S MEDICAL GROUP OF GREENWICH, PC
Entity type:Organization
Organization Name:THE CHILDREN'S MEDICAL GROUP OF GREENWICH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-661-2440
Mailing Address - Street 1:42 SHERWOOD PLACE
Mailing Address - Street 2:THE CHILDREN'S MEDICAL GROUP
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-1622
Mailing Address - Country:US
Mailing Address - Phone:203-661-2440
Mailing Address - Fax:
Practice Address - Street 1:42 SHERWOOD PLACE
Practice Address - Street 2:THE CHILDREN'S MEDICAL GROUP
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5638
Practice Address - Country:US
Practice Address - Phone:203-661-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty