Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jefferson Park Pediatrics P C

Organization Specialist · NPI 1629263181

Jefferson Park Pediatrics P C is a Specialist in Fort Wayne, Indiana. Works from 2 locations. Registered with an NPI since 2007.

In the registry since
2007
Specialties on file
5
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Practice location Address checks out

3919 W Jefferson Blvd Ste 1
Fort Wayne, IN 46804-6811
Phone: (260) 436-7722
Fax: (260) 459-0012
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3919 W Jefferson Blvd Ste 2, Fort Wayne, IN 46804-6811 — (260) 450-1313

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X
Specialist Taxonomy 174400000X
Integrative Medicine Physician Taxonomy 202D00000X
Dermatology Physician Taxonomy 207N00000X
Family Medicine Physician Taxonomy 207Q00000X

Record details

NPI number1629263181
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Giridhar Veerula — Owner · (260) 436-7722
NPI enumeratedSeptember 7, 2007
Last updated in NPPESApril 23, 2025
Certification dateApril 23, 2025
Mailing address3919 W Jefferson Blvd Ste 1, Fort Wayne, IN 46804-6811

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