Healthcare Provider Details

I. General information

NPI: 1952804783
Provider Name (Legal Business Name): MARYLAND PEDIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19514 DOCTORS DR
GERMANTOWN MD
20874-5200
US

IV. Provider business mailing address

19514 DOCTORS DR
GERMANTOWN MD
20874-5200
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-2400
  • Fax:
Mailing address:
  • Phone: 301-424-2400
  • Fax:

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. ANIQA MALIK
Title or Position: MEMBER
Credential: MD
Phone: 484-860-6780