Healthcare Provider Details

I. General information

NPI: 1194722306
Provider Name (Legal Business Name): WHITE OAK PEDIATRICS, DRS. BATTIATA & IMPEDUGLIA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 RUSSELL AVE STE 301
GAITHERSBURG MD
20879-3257
US

IV. Provider business mailing address

903 RUSSELL AVE STE 301
GAITHERSBURG MD
20879-3257
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-2292
  • Fax: 877-673-1105
Mailing address:
  • Phone: 301-869-2292
  • Fax: 877-673-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD003342
License Number StateMD

VIII. Authorized Official

Name: HANNAH COHEN
Title or Position: CEO
Credential:
Phone: 720-635-0992