Provider Demographics
NPI:1689770349
Name:PEDIATRIC PULMONARY ASSOCIATES INC
Entity type:Organization
Organization Name:PEDIATRIC PULMONARY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAUTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-291-2207
Mailing Address - Street 1:2121 HUGHES DR STE 640
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5126
Mailing Address - Country:US
Mailing Address - Phone:419-291-4261
Mailing Address - Fax:419-479-6061
Practice Address - Street 1:2121 HUGHES DR STE 640
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5126
Practice Address - Country:US
Practice Address - Phone:419-291-4261
Practice Address - Fax:419-479-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0582712Medicaid
OH0582712Medicaid