Healthcare Provider Details

I. General information

NPI: 1205759180
Provider Name (Legal Business Name): BETHANY PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300A BALTIMORE NATIONAL PIKE
ELLICOTT CITY MD
21042-2128
US

IV. Provider business mailing address

10300A BALTIMORE NATIONAL PIKE
ELLICOTT CITY MD
21042-2128
US

V. Phone/Fax

Practice location:
  • Phone: 410-465-7337
  • Fax: 410-465-1620
Mailing address:
  • Phone: 410-465-7337
  • Fax: 410-465-1620

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. AMAKA J UNDIE
Title or Position: PHYSICIAN
Credential: MD
Phone: 410-465-7337