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General NPI Number Information
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NPI Number | 1063523280
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Entity Type | Organization
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Legal Business Name | LARGO PEDIATRICS
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 8700 CENTRAL AVE STE 203
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City | LANDOVER
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State | MD
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Zip | 20785-4868
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Country | US
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Telephone | 301-350-0044
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Fax | 301-350-8007
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Provider Business Mailing Address
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Address Line | PO BOX 1817
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City | MITCHELLVILLE
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State | MD
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Zip | 20717-1817
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Country | US
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Telephone | 301-350-0044
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Fax | 301-350-8007
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTORIA GAHOL VENIDA
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Credential | M.D.
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Telephone | 301-350-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0027190
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License Number State | MD
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