Provider Demographics
NPI:1528084332
Name:MID-FLORIDA PEDIATRICS PA
Entity type:Organization
Organization Name:MID-FLORIDA PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANJIT
Authorized Official - Middle Name:JUNEJA
Authorized Official - Last Name:VIRDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-975-0681
Mailing Address - Street 1:2340 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3314
Mailing Address - Country:US
Mailing Address - Phone:407-975-0681
Mailing Address - Fax:407-975-0683
Practice Address - Street 1:2340 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3314
Practice Address - Country:US
Practice Address - Phone:407-975-0681
Practice Address - Fax:407-975-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty