Healthcare Provider Details

I. General information

NPI: 1154451094
Provider Name (Legal Business Name): ANNAPOLIS PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FORBES ST SUITE 200
ANNAPOLIS MD
21401-1538
US

IV. Provider business mailing address

200 FORBES ST SUITE 200
ANNAPOLIS MD
21401-1538
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-6363
  • Fax: 410-263-4086
Mailing address:
  • Phone: 410-263-6363
  • Fax: 410-263-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0008188
License Number StateMD

VIII. Authorized Official

Name: DR. DWIGHT NORBERT FORTIER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 410-263-6363