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Contact Information

PROVIDENCE PEDIATRICS, PC
338 RUSSELL AVENUE
WILLIAMSPORT, PA17701
 Phone: 570-326-5720
 Fax: 570-601-1522
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Adolescent Medicine

2080A0000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PROVIDENCE PEDIATRICS PC · (Female)

NPI Number 1265575955
Status Active
Credentials
Entity Individual
Enumeration date 02/14/2007
Last updated 01/11/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • PA License # MD046306-L
  • PA License # MD046306L
  • PA Medicaid 0012712310004
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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