Provider Demographics
NPI:1528053253
Name:PEDIATRIC & ADOLESCENT CARE INC
Entity type:Organization
Organization Name:PEDIATRIC & ADOLESCENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-349-0067
Mailing Address - Street 1:33001 SOLON RD
Mailing Address - Street 2:STE 206
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2839
Mailing Address - Country:US
Mailing Address - Phone:440-349-0067
Mailing Address - Fax:440-349-0292
Practice Address - Street 1:33001 SOLON RD
Practice Address - Street 2:STE 206
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2839
Practice Address - Country:US
Practice Address - Phone:440-349-0067
Practice Address - Fax:440-349-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043707208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457956Medicaid