Provider Demographics
NPI:1902951858
Name:SYLVA PEDIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:SYLVA PEDIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-586-5594
Mailing Address - Street 1:186 MEDICAL PARK LOOP
Mailing Address - Street 2:STE 501
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5222
Mailing Address - Country:US
Mailing Address - Phone:828-586-5594
Mailing Address - Fax:828-586-3040
Practice Address - Street 1:186 MEDICAL PARK LOOP
Practice Address - Street 2:STE 501
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5222
Practice Address - Country:US
Practice Address - Phone:828-586-5594
Practice Address - Fax:828-586-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902793Medicaid
NC02793OtherBCBS ST OF NC GROUP NO