Healthcare Provider Details

I. General information

NPI: 1467025379
Provider Name (Legal Business Name): PEDS WORLD ASSOCIATES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 WILKENS AVE STE 308
BALTIMORE MD
21229-5218
US

IV. Provider business mailing address

3449 WILKENS AVE STE 308
BALTIMORE MD
21229-5218
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-1200
  • Fax: 410-646-1211
Mailing address:
  • Phone: 410-646-1200
  • Fax: 410-646-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DORA CECILIA RIOJA-MAZZA
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 202-378-4100