Provider Demographics
NPI:1730516659
Name:MT. AIRY PEDIATRICS, P.C.
Entity type:Organization
Organization Name:MT. AIRY PEDIATRICS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS JADOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-247-2996
Mailing Address - Street 1:6673 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2252
Mailing Address - Country:US
Mailing Address - Phone:215-247-2996
Mailing Address - Fax:215-247-7504
Practice Address - Street 1:6673 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2252
Practice Address - Country:US
Practice Address - Phone:215-247-2996
Practice Address - Fax:215-247-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000465921OtherBLUE SHIELD/HIGH MARK
PA1781620OtherUNITED HEALTHCARE
PA6524OtherAETNA
PA1026452OtherKEYSTONE MERCY
PA0055732001OtherINDEPENDENCE BLUE CROSS