Provider Demographics
NPI:1427157015
Name:WEE CARE PEDIATRICS GROUP PLLC
Entity type:Organization
Organization Name:WEE CARE PEDIATRICS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICRISTOFARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-399-5437
Mailing Address - Street 1:2860 3RD AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1454
Mailing Address - Country:US
Mailing Address - Phone:304-399-5437
Mailing Address - Fax:304-399-1104
Practice Address - Street 1:2860 3RD AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1454
Practice Address - Country:US
Practice Address - Phone:304-399-5437
Practice Address - Fax:304-399-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000165Medicaid