NPIMap

Organization Active NPI

Pediatric Associates of Watertown P.C.

  • Pediatrics Physician
  • Watertown, NY
National Provider Identifier
1497855670
Registry record updated Feb 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF WATERTOWN P.C.
Practice address
18969 US Route 11
Watertown, NY 13601-5320
Phone
(315) 782-4391
Fax
(315) 788-8319
NPI assigned
Sep 25, 2006
Last updated
Feb 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2012

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

Authorized official

Name
Dr. Mario F. Victoria, M.D.NPI 1811947393
Title
President
Phone
(315) 782-4391

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

18969 US Route 11
Watertown, NY 13601-5320

Mailing address

PO Box 6600
Watertown, NY 13601-6600
Phone (315) 782-4391

National Provider Directory

National Provider Directory

Locations

18969 US Route 11
Watertown, NY 13601
Phone (315) 782-1992

20011 Summit View Blvd
Watertown, NY 13601
Phone (315) 782-4391

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1497855670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6600",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016600",
            "telephone_number": "315-782-4391",
            "fax_number": "315-788-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18969 US ROUTE 11",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015320",
            "telephone_number": "315-782-4391",
            "fax_number": "315-788-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF WATERTOWN P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "VICTORIA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-782-4391",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; 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.