Healthcare Provider Details

I. General information

NPI: 1003986704
Provider Name (Legal Business Name): DUNDALK PEDIATRIC ASSOCIATES, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 MERRITT BLVD
DUNDALK MD
21222-3212
US

IV. Provider business mailing address

1792 MERRITT BLVD
DUNDALK MD
21222-3212
US

V. Phone/Fax

Practice location:
  • Phone: 410-284-1133
  • Fax: 410-284-3371
Mailing address:
  • Phone: 410-284-1133
  • Fax: 410-284-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARA HINSON
Title or Position: PRACTICE ADMIN
Credential:
Phone: 410-284-1133