Healthcare Provider Details

I. General information

NPI: 1477036127
Provider Name (Legal Business Name): PANDA PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW STE 422
WASHINGTON DC
20037-1422
US

IV. Provider business mailing address

2440 M STREET NW, SUITE 422 STREET LINE 2
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 703-585-0304
  • Fax:
Mailing address:
  • Phone: 703-585-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD15758
License Number StateDC

VIII. Authorized Official

Name: AMY B. PULLMAN
Title or Position: OWNER
Credential: MD
Phone: 703-585-0304