Provider Demographics
NPI:1053887612
Name:ST. GIANNA PEDIATRICS, LLC
Entity type:Organization
Organization Name:ST. GIANNA PEDIATRICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-808-5354
Mailing Address - Street 1:7387 WATSON ROAD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MO
Mailing Address - Zip Code:63119
Mailing Address - Country:US
Mailing Address - Phone:314-500-5437
Mailing Address - Fax:314-500-5683
Practice Address - Street 1:7387 WATSON ROAD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MO
Practice Address - Zip Code:63119
Practice Address - Country:US
Practice Address - Phone:314-500-5437
Practice Address - Fax:314-500-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty