Healthcare Provider Details

I. General information

NPI: 1710174115
Provider Name (Legal Business Name): FOREST HILL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ROCK SPRING RD SUITE#1
FOREST HILL MD
21050-2621
US

IV. Provider business mailing address

2005 ROCK SPRING RD SUITE#1
FOREST HILL MD
21050-2621
US

V. Phone/Fax

Practice location:
  • Phone: 410-420-1743
  • Fax:
Mailing address:
  • Phone: 410-420-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0045867
License Number StateMD

VIII. Authorized Official

Name: DR. GRACE KOBUSINGYE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-420-1743