FAIRWAY PEDIATRICS, PLLC (NPI# 1821340472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821340472 |
| Entity Type | Organization |
| Organization Name | FAIRWAY PEDIATRICS, PLLC |
| Practice Address |
4100 Fairway Dr Suite 300 Carrollton TX 75010-6525 |
| Practice Telephone | 9724928880 |
| Practice Fax Number | 9724928818 |
| Mailing Telephone | 9724928880 |
| Mailing Fax Number | 9724928818 |
| Enumeration Date | 2012-10-06 |
| Last Update Date | 2013-01-07 |
| Authorized Official Name | JIAN WANG (OWNER) |
| Authorized Official Telephone | 4698552073 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | K6737 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 3079857-01 | 05 |
| Street Address |
4100 FAIRWAY DR SUITE 300 |
| City | CARROLLTON |
| State | TX |
| Zip Code | 75010-6525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316944366 | Alison Jennifer Taylor | Occupational Therapist | 4100 Fairway Dr, Ste 400, Carrollton, TX 75010-6525 | 2005-07-06 |
| 1144777814 | Amanda M Warneke | Physician Assistant | 4100 Fairway Dr, Suite 100, Carrollton, TX 75010-6525 | 2016-09-09 |
| 1093174062 | Jessica M. Novak | Physical Therapist | 4100 Fairway Dr, Suite 400, Carrollton, TX 75010-6525 | 2016-02-18 |
| 1851715304 | Tms Neuro Solutions, LLC | Clinic/Center | 4100 Fairway Dr, Suite 200, Carrollton, TX 75010-6525 | 2014-02-04 |
| 1508115718 | Fairway Family Medicine-primary Care, Pllc | Clinic/Center | 4100 Fairway Dr, 320, Carrollton, TX 75010-6525 | 2012-09-04 |
| 1992071724 | Thomas Adams | Physical Therapist | 4100 Fairway Dr, Suite 400, Carrollton, TX 75010-6525 | 2012-03-27 |
| 1134491046 | Summit Behavioral Health Pllc | Psychiatry & Neurology | 4100 Fairway Dr, Bldg # 200, Carrollton, TX 75010-6525 | 2012-02-08 |
| 1093099558 | Realtime Laboratories, Inc | Clinical Medical Laboratory | 4100 Fairway Dr, Ste 600, Carrollton, TX 75010-6525 | 2011-10-03 |
| 1982907465 | Lisa Renee Reznick Md, Pa | Durable Medical Equipment & Medical Supplies | 4100 Fairway Dr, Suite 120, Carrollton, TX 75010-6525 | 2010-12-06 |
| 1508910316 | Charles Steven Manley | Psychologist | 4100 Fairway Dr, Ste. 200, Carrollton, TX 75010-6525 | 2007-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043782907 | Timothy C. Pringle Md Pa | Surgery | 4541 N. Josey Lane, Suite 140, Carrollton, TX 75010 | 2018-12-17 |
| 1184106411 | Cindy T Vu | Occupational Therapy Assistant | 1877 Cheyenne, Carrollton, TX 75010 | 2018-09-04 |
| 1639686256 | Little Lantern Hospice LLC | Hospice Care, Community Based | 4541 North Josey Lane, Suite 110-b, Carrollton, TX 75010 | 2018-01-04 |
| 1235681610 | Kahini Shah | Physical Therapist | 1012 W Hebron Pkwy Ste 124, Carrollton, TX 75010 | 2016-11-01 |
| 1881148849 | Wais Azesh | Dentist | 1233 Apache Lake Dr, Carrollton, TX 75010 | 2016-08-08 |
| 1225485055 | Julia Buckelew | Physical Therapist | 4100 Fairway Dr Ste 400, Carrollton, TX 75010 | 2016-05-23 |
| 1811355639 | Fastpass Ucc, Pllc | Clinic/Center | 4228 N Josey Ln Ste 150, Carrollton, TX 75010 | 2016-02-08 |
| 1326404393 | Miaojuan Li | Nurse Practitioner | 4100 Fairway Dr Ste 300, Carrollton, TX 75010 | 2016-01-06 |
| 1912376112 | Envoy Hospice North LLC | Hospice Care, Community Based | 4040 Tx-121, Carrollton, TX 75010 | 2015-09-17 |
| 1932593936 | Lifeway Hospice, LLC | Hospice Care, Community Based | 4040 State Highway 121, Suite 140, Carrollton, TX 75010 | 2015-03-27 |
| Find all providers in zip 75010 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124480348 | Neha Rao Manikonda | Pediatrics | 3044 Old Denton Rd Ste 138, Carrollton, TX 75007-5099 | 2016-03-26 |
| 1093993404 | Michelle S Tucker | Pediatrics | 1821 Golden Trail Ct Ste 200, Carrollton, TX 75010-4675 | 2008-02-07 |
| 1013112341 | Jyoti Sridhar Murthy | Pediatrics | 3044 Old Denton Road, Suite 138, Carrollton, TX 75007-5099 | 2007-06-18 |
| 1124245634 | D.b.a. Sand Hill Pediatrics | Pediatrics | 305 Prizm Dr, Carrollton, GA 30116-5596 | 2007-04-19 |
| 1245329135 | Margarita Maria Miller | Pediatrics | 2801 North I35 East, Suite #110, Carrollton, TX 75007 | 2006-10-11 |
| 1457458259 | Farah Naz | Pediatrics | 2459 E Hebron Pkwy, Suite 100, Carrollton, TX 75010-4482 | 2006-09-20 |
| 1003826496 | Thomas E. Grubb | Pediatrics | 4443 N Josey Ln Ste 160, Carrollton, TX 75010-4676 | 2006-08-08 |
| 1497785554 | Monica J Beamer | Pediatrics | 4443 N Josey Ln Ste 150, Carrollton, TX 75010-4680 | 2006-07-04 |
| 1801861562 | Tammy Anita Lyles-arnold | Pediatrics | 205 Bankhead Hwy, Carrollton, GA 30117-3427 | 2006-02-17 |
| 1306820477 | Eric H Baret | Pediatrics | 410 Newnan St, Carrollton, GA 30117-3111 | 2005-12-02 |
| Find all providers in CARROLLTON | ||||
| City | CARROLLTON |
| Zip Code | 75010 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.