Healthcare Provider Details

I. General information

NPI: 1659025559
Provider Name (Legal Business Name): ABOVE & BEYOND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12070 OLD LINE CTR STE 212
WALDORF MD
20602-2567
US

IV. Provider business mailing address

12070 OLD LINE CTR STE 212
WALDORF MD
20602-2567
US

V. Phone/Fax

Practice location:
  • Phone: 301-818-3799
  • Fax:
Mailing address:
  • Phone: 301-710-0455
  • Fax: 301-710-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TUERE HUGHES-KAPENZI
Title or Position: OWNER
Credential: MD, MBA
Phone: 301-818-3799