Provider Demographics
NPI:1780705392
Name:PEDIATRIC ASSOCIATES OF LOUISVILLE, PLLC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF LOUISVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-231-1144
Mailing Address - Street 1:5721 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1913
Mailing Address - Country:US
Mailing Address - Phone:502-231-1144
Mailing Address - Fax:502-231-1508
Practice Address - Street 1:5721 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1913
Practice Address - Country:US
Practice Address - Phone:502-231-1144
Practice Address - Fax:502-231-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty