Healthcare Provider Details

I. General information

NPI: 1225257561
Provider Name (Legal Business Name): PADEN-LIFE-CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OXFORD SHIRE CT
WALDORF MD
20603-3215
US

IV. Provider business mailing address

2300 OXFORD SHIRE CT
WALDORF MD
20603-3215
US

V. Phone/Fax

Practice location:
  • Phone: 301-843-1279
  • Fax: 301-638-5512
Mailing address:
  • Phone: 301-843-1279
  • Fax: 301-638-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0060744
License Number StateMD

VIII. Authorized Official

Name: DR. VABIAN LEWITT PADEN
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 240-682-5440