MEDICARE: URBANA PEDIATRICS, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D0061468	OTHER	MD	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1871050609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBANA PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	3534 URBANA PIKE STE A
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7786
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3534 URBANA PIKE STE A
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7786
Country	:	US
Telephone Number	:	301-788-9490
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. JENNIFER BURNS
Credential	:	MD
Telephone Number	:	301-788-9490

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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