Healthcare Provider Details

I. General information

NPI: 1376599308
Provider Name (Legal Business Name): HEALTH CARE FOR CHILDREN,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH ST STE A
ELKTON MD
21921-5505
US

IV. Provider business mailing address

PO BOX 309
ELKTON MD
21922-0309
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-8899
  • Fax: 410-398-1477
Mailing address:
  • Phone: 410-398-8899
  • Fax: 410-398-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AGNES LOPEZ DALIVA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 410-398-8899