Healthcare Provider Details

I. General information

NPI: 1689134124
Provider Name (Legal Business Name): PM KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 ALTAMONT PL STE 201
WHITE PLAINS MD
20695-3065
US

IV. Provider business mailing address

4225 ALTAMONT PL STE 201
WHITE PLAINS MD
20695-3065
US

V. Phone/Fax

Practice location:
  • Phone: 240-585-7128
  • Fax:
Mailing address:
  • Phone: 240-585-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. WALI GAUVIN
Title or Position: CO-OWNER
Credential: MD
Phone: 516-456-4706