Healthcare Provider Details

I. General information

NPI: 1386443208
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF THE MID-ATLANTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 ROCKVILLE PIKE STE C25
ROCKVILLE MD
20852-3063
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 301-761-4760
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GLASER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 954-384-0175