Healthcare Provider Details

I. General information

NPI: 1144964156
Provider Name (Legal Business Name): XPRESS PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 REISTERSTOWN RD
PIKESVILLE MD
21208-3808
US

IV. Provider business mailing address

1419 REISTERSTOWN RD
PIKESVILLE MD
21208-3808
US

V. Phone/Fax

Practice location:
  • Phone: 240-376-1616
  • Fax: 855-825-6158
Mailing address:
  • Phone: 240-376-1616
  • Fax: 855-825-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJENDER KUMAR GATTU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 240-616-1616