Healthcare Provider Details

I. General information

NPI: 1558371468
Provider Name (Legal Business Name): NEXT STEP PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DRIVE SUITE 311
TOWSON MD
21204
US

IV. Provider business mailing address

7600 OSLER DRIVE SUITE 311
TOWSON MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-2300
  • Fax: 410-296-3444
Mailing address:
  • Phone: 410-296-2300
  • Fax: 410-296-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0054956
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JORDAN THAYER ROBINSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 410-296-2300