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Contact Information

BACK MOUNTAIN PEDIATRICS
550 MEMORIAL HIGHWAY
DALLAS, PA18612
 Phone: 570-675-7955
 Fax: 570-675-7882
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
Indicates primary specialty

NPI Profile & details for BACK MOUNTAIN PEDIATRICS · (Female)

NPI Number 1063621233
Status Active
Credentials
Entity Individual
Enumeration date 05/22/2007
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Not specified
Identifiers
  • PA License # 022874
  • PA License # MD024845E
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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