Pediatric Associate

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

WV11941 Issued in WV

Legal business name

PEDIATRIC ASSOCIATE

Practice address

11 Chenoweth Dr
Suite a
Bridgeport, WV 26330-1675

Phone

(304) 842-5777

Fax

(304) 842-3318

NPI assigned

Oct 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Manzar Momen, MD

Title

Office Manager

Phone

(304) 842-5777

Specialties & licenses 1

Addresses

Tax ID family

Pediatric Associate2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Associate

  • Legal Medicine
  • Bridgeport, WV
  • NPI 1104937416
  NPD tax ID

Practitioners 1

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.

• Jennifer Jill Momen

  • Pediatrics Physician
  • Bridgeport, WV
  • NPI 1023127818
  NPD (past)

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538256805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CHENOWETH DR",
            "address_2": "SUITE A",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301675",
            "telephone_number": "304-842-5777",
            "fax_number": "304-842-3318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CHENOWETH DR",
            "address_2": "SUITE A",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301675",
            "telephone_number": "304-842-5777",
            "fax_number": "304-842-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOMEN",
        "authorized_official_first_name": "MANZAR",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-842-5777",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "WV11941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Kristine Paugh
• Ivy Riccole Paugh
• Timothy M Peasak, D.O.
• Pediatric and Adolescent Dentistry
• Pediatric Associate
• Wesley S Pepper, D.C.
• Azalee Perrine, CM
• Christel Pervola
• Andrea J Peters, LGSW
• Marcus A Peters, MD

• Clinical Medical Laboratory in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Clinical Medical Laboratory in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.