Healthcare Provider Details

I. General information

NPI: 1598779886
Provider Name (Legal Business Name): THE PEDIATRIC GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 RUTLAND RD
DAVIDSONVILLE MD
21035-1228
US

IV. Provider business mailing address

2225 DEFENSE HWY STE E
CROFTON MD
21114-2468
US

V. Phone/Fax

Practice location:
  • Phone: 410-451-2116
  • Fax: 410-721-2656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT G. GRAW JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-721-2273