Healthcare Provider Details

I. General information

NPI: 1437976388
Provider Name (Legal Business Name): PEDIATRIC PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 POOLE RD
WESTMINSTER MD
21157-6003
US

IV. Provider business mailing address

4C NORTH AVE STE 400
BEL AIR MD
21014-2333
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-1019
  • Fax: 410-751-9891
Mailing address:
  • Phone: 410-638-0537
  • Fax: 240-383-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISSY L OFF
Title or Position: BUSINESS MANAGER
Credential:
Phone: 410-638-0537