Provider Demographics
NPI:1548272651
Name:CARDINAL PEDIATRICS PLLC
Entity type:Organization
Organization Name:CARDINAL PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-599-8000
Mailing Address - Street 1:1247 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-599-8000
Mailing Address - Fax:304-599-8003
Practice Address - Street 1:1247 SUNCREST TOWNE CENTRE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-8000
Practice Address - Fax:304-599-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========001OtherWV STATE BUSINESS LICENSE