Healthcare Provider Details

I. General information

NPI: 1982960464
Provider Name (Legal Business Name): ABC PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S NEW ST
DOVER DE
19904-3571
US

IV. Provider business mailing address

740 S NEW ST
DOVER DE
19904-3571
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-0222
  • Fax: 302-674-0200
Mailing address:
  • Phone: 302-674-0222
  • Fax: 302-674-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10006010
License Number StateDE

VIII. Authorized Official

Name: MR. MAMOON MAHMOUD
Title or Position: PHYSICIAN
Credential: MD
Phone: 302-883-3266