Provider Demographics
NPI:1467855254
Name:KIDS AND TEENS PEDIATRICS OF DOVER
Entity type:Organization
Organization Name:KIDS AND TEENS PEDIATRICS OF DOVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FUNDERBURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-264-9386
Mailing Address - Street 1:125 GREENTREE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7656
Mailing Address - Country:US
Mailing Address - Phone:302-264-9386
Mailing Address - Fax:
Practice Address - Street 1:125 GREENTREE DR STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7656
Practice Address - Country:US
Practice Address - Phone:302-264-9386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty