| Organization Name: | BERWYN PEDIATRICS |
| NPI Number: | 1033582788 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MELISA MAROTTA (PEDIATRIC NURSE PRACTITIONER) |
| Mailing Address: | 2842 Mayfair Ave Westchester |
| State: | IL US |
| Postal Code: | 601545009 |
| Phone Number: | 8478480044 |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2015 |
| NPI Last Update Date: | 12/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 209012844 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |