National Provider Identifier Database

JEFFERSON PARK PEDIATRICS P C
Pediatrics

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.


Contact Information

JEFFERSON PARK PEDIATRICS P C
3919 W JEFFERSON BLVD STE 1
FORT WAYNE, IN46804-6811
Phone: 260-436-7722
Fax: 260-459-0012
Website:
Specialty Taxonomy Code
* Pediatrics 208000000X
Dermatology 207N00000X
Family Medicine 207Q00000X
Integrative Medicine 202D00000X
Specialist 174400000X

* Indicates primary specialty

NPI Profile & details for JEFFERSON PARK PEDIATRICS P C

NPI Number 1629263181
Legal business name
LBN
JEFFERSON PARK PEDIATRICS P C
Authorized official GIRIDHAR VEERULA - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 09/07/2007
Last updated 04/23/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • IN Medicaid: 200262620

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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