NPIMap

Organization Active NPI

Pediatric Associates of Warren

  • Pediatrics Physician
  • Warren, OH
National Provider Identifier
1720035587
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35-06-1915-K Issued in OH
Legal business name
PEDIATRIC ASSOCIATES OF WARREN
Practice address
321 Niles Cortland Rd NE
Warren, OH 44484-1974
Phone
(330) 609-5588
Fax
(330) 609-5740
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Pete Kondolios, M.D.
Title
President
Phone
(330) 609-5588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 35-06-1915-K OH Primary

Addresses

Primary practice location

321 Niles Cortland Rd NE
Warren, OH 44484-1974

Mailing address

321 Niles Cortland Rd NE
Warren, OH 44484-1974
Phone (330) 609-5588

Other identifiers 3

IdentifierTypeStateIssuer
2510812MedicaidOH
23688978MedicaidOH
0942485MedicaidOH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720035587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 NILES CORTLAND RD NE",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444841974",
            "telephone_number": "330-609-5588",
            "fax_number": "330-609-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 NILES CORTLAND RD NE",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444841974",
            "telephone_number": "330-609-5588",
            "fax_number": "330-609-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF WARREN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KONDOLIOS",
        "authorized_official_first_name": "PETE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-609-5588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35-06-1915-K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2510812",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23688978",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0942485",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • 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.