Provider Demographics
NPI:1871711184
Name:ROWLETT PEDIATRICS
Entity type:Organization
Organization Name:ROWLETT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-681-7700
Mailing Address - Street 1:1600 REPUBLIC PKWY
Mailing Address - Street 2:BAYLOR MEDICAL PLAZA SUITE 140
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6918
Mailing Address - Country:US
Mailing Address - Phone:972-681-7700
Mailing Address - Fax:972-681-7704
Practice Address - Street 1:1600 REPUBLIC PKWY
Practice Address - Street 2:BAYLOR MEDICAL PLAZA SUITE 140
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6918
Practice Address - Country:US
Practice Address - Phone:972-681-7700
Practice Address - Fax:972-681-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA62334Medicare UPIN