MEDICARE: LARGO PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	D0027190	MD

General Provider Information

NPI Number	:	1063523280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARGO PEDIATRICS

Provider Business Mailing Address
First Line	:	PO BOX 1817
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20717-1817
Country	:	US
Telephone Number	:	301-350-0044
Fax Number	:	301-350-8007

Provider Business Practice Location Address
First Line	:	8700 CENTRAL AVE STE 203
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4868
Country	:	US
Telephone Number	:	301-350-0044
Fax Number	:	301-350-8007

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTORIA GAHOL VENIDA
Credential	:	M.D.
Telephone Number	:	301-350-0044

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/21/2011

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Directions to “LARGO PEDIATRICS ” Practice Location

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