PROVIDENCE PEDIATRICS PC NPI 1265575955

NPI Information

  • NPI: 1265575955
  • Provider Name: PROVIDENCE PEDIATRICS, PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Other Name: PROVIDENCE PEDIATRICS
  • CLIA Number: 39D0692381
  • Address: 338 RUSSELL AVENUE
    WILLIAMSPORT, PA
    ZIP 17701
  • Phone: (570) 326-5720

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NPI Details

PROVIDENCE PEDIATRICS, PC is a pediatrics in Williamsport, PA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PROVIDENCE PEDIATRICS, PC NPI is 1265575955. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Other Name Is Providence Pediatrics.

The provider's business location address is:

338 RUSSELL AVENUE
WILLIAMSPORT, PA
ZIP 17701
Phone: (570) 326-5720
Fax: (570) 601-1522

The provider's authorized official is Joseph Demay .
The authorized official title is President and has the following contact phone number (570) 326-5720.

The CLIA number assigned to this NPI record is 39D0692381 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2007 and was last updated on 1/11/2011.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent MedicineMD046306LPENNSYLVANIANo
2208000000XPediatricsMD046306-LPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10012712310004MEDICAIDPENNSYLVANIA
2F17389MEDICARE UPINPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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