Healthcare Provider Details

I. General information

NPI: 1780438457
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINOLOGY OF ANNAPOLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 RIVERSIDE DR STE B102
SALISBURY MD
21801-4701
US

IV. Provider business mailing address

2024 WEST ST STE 304
ANNAPOLIS MD
21401-3556
US

V. Phone/Fax

Practice location:
  • Phone: 443-203-8202
  • Fax: 443-203-8601
Mailing address:
  • Phone: 443-203-8202
  • Fax: 443-203-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA I PAGAN PARES
Title or Position: OWNER
Credential: MD
Phone: 443-203-8202