Healthcare Provider Details

I. General information

NPI: 1386687614
Provider Name (Legal Business Name): LIGIA PERALTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ELTON RD STE 200
SILVER SPRING MD
20903-1766
US

IV. Provider business mailing address

1700 ELTON RD STE 200
SILVER SPRING MD
20903-1766
US

V. Phone/Fax

Practice location:
  • Phone: 301-445-2500
  • Fax: 301-650-0606
Mailing address:
  • Phone: 301-445-2500
  • Fax: 301-650-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD41170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: