Healthcare Provider Details

I. General information

NPI: 1831507847
Provider Name (Legal Business Name): PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 NEW HAMPSHIRE AVE STE 302
TAKOMA PARK MD
20912-6972
US

IV. Provider business mailing address

7505 NEW HAMPSHIRE AVE STE 302
TAKOMA PARK MD
20912-6972
US

V. Phone/Fax

Practice location:
  • Phone: 301-434-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD61511
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NDIDI AGHOLOR
Title or Position: OWNER
Credential:
Phone: 301-434-8800