Healthcare Provider Details

I. General information

NPI: 1689705725
Provider Name (Legal Business Name): PARKER, COHEN, DECONCINI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 OLD COLUMBIA PIKE #300
SILVER SPRING MD
20904-1656
US

IV. Provider business mailing address

12301 OLD COLUMBIA PIKE #300
SILVER SPRING MD
20904-1656
US

V. Phone/Fax

Practice location:
  • Phone: 301-625-2800
  • Fax:
Mailing address:
  • Phone: 301-625-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD30739
License Number StateMD

VIII. Authorized Official

Name: DR. PAMELA PARKER
Title or Position: OWNER
Credential: MD
Phone: 301-625-2800