Healthcare Provider Details

I. General information

NPI: 1720050149
Provider Name (Legal Business Name): DAYSPRING PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RYAN DR
RISING SUN MD
21911-1840
US

IV. Provider business mailing address

120 RYAN DR
RISING SUN MD
21911-1840
US

V. Phone/Fax

Practice location:
  • Phone: 410-658-1300
  • Fax: 410-658-1828
Mailing address:
  • Phone: 410-658-1300
  • Fax: 410-658-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. REYNALDO APIADO EBREO
Title or Position: OWNER
Credential: M.D.
Phone: 410-658-1300