PEDICORP PC NPI 1952581928

NPI Information

PEDICORP, PC is an adolescent medicine pediatrics in West Hartford, CT. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PEDICORP, PC NPI is 1952581928. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

345 N MAIN ST
SUITE 248
WEST HARTFORD, CT
ZIP 06117-515
Phone: (860) 231-8453
Fax: (860) 523-4061

The provider's authorized official is Ellen Guertin .
The authorized official title is Practice Manager and has the following contact phone number (860) 231-8453.

The CLIA number assigned to this NPI record is 07D0094535 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2007 and was last updated on 11/7/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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