Healthcare Provider Details

I. General information

NPI: 1649730474
Provider Name (Legal Business Name): PAIGE KENNEDY-WINSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15204 OMEGA DR STE 100
ROCKVILLE MD
20850-4812
US

IV. Provider business mailing address

15204 OMEGA DR STE 100
ROCKVILLE MD
20850-4812
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-6750
  • Fax:
Mailing address:
  • Phone: 301-279-6750
  • Fax: 301-208-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD210001897
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0097026
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: