NPIMap

Organization Active NPI

Pennsboro Pediatrics, LLC

  • Pediatrics Physician
  • Enola, PA
National Provider Identifier
1760588552
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PENNSBORO PEDIATRICS, LLC
Practice address
125 N Enola Dr
Ste 101
Enola, PA 17025-2500
Phone
(717) 732-7171
Fax
(717) 732-8872
NPI assigned
Sep 16, 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. Richard Blutstein, MDNPI 1508892167
Title
Manager
Phone
(717) 732-7171

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

125 N Enola Dr
Ste 101
Enola, PA 17025-2500

Mailing address

125 N Enola Dr
Ste 101
Enola, PA 17025-2500
Phone (717) 732-7171

National Provider Directory

National Provider Directory

Locations

125 N Enola Dr
Ste 101
Enola, PA 17025
Phone (717) 640-5777

Practitioners & affiliated clinicians

Practitioners 2

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": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760588552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N ENOLA DR",
            "address_2": "STE 101",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170252500",
            "telephone_number": "717-732-7171",
            "fax_number": "717-732-8872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N ENOLA DR",
            "address_2": "STE 101",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170252500",
            "telephone_number": "717-732-7171",
            "fax_number": "717-732-8872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSBORO PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLUTSTEIN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "717-732-7171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enola, PA

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.