Pediatric MD Services, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME90011 Issued in FL

Legal business name

PEDIATRIC MD SERVICES, LLC

Practice address

1325 S Congress Ave
Suite 109
Boynton Beach, FL 33426-5876

Phone

(561) 736-2510

Fax

(561) 503-4873

NPI assigned

Oct 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Suzanne Pavlou, MD

Title

President/Ceo

Phone

(561) 736-2510

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221955200000",
    "number": "1336328046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 S CONGRESS AVE",
            "address_2": "SUITE 109",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334265876",
            "telephone_number": "561-736-2510",
            "fax_number": "561-503-4873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S CONGRESS AVE",
            "address_2": "SUITE 109",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334265876",
            "telephone_number": "561-736-2510",
            "fax_number": "561-503-4873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC MD SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2008-09-21",
        "status": "A",
        "authorized_official_last_name": "PAVLOU",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "561-736-2510",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME90011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270305000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.