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General NPI Number Information
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NPI Number | 1093724163
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Entity Type | Organization
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Legal Business Name | PLUMTREE PEDIATRICS, LLC
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Dates
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Enumeration Date | 08/06/2006
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 2014 S TOLLGATE RD SUITE 200
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City | BEL AIR
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State | MD
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Zip | 21015-5903
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Country | US
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Telephone | 410-569-9533
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Fax | 410-569-1254
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Provider Business Mailing Address
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Address Line | 2014 S TOLLGATE RD SUITE 200
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City | BEL AIR
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State | MD
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Zip | 21015-5903
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Country | US
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Telephone | 410-569-9533
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Fax | 410-569-1254
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GENEROSA CRUZ LAZOR
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Credential | MD
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Telephone | 410-569-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | D34413
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License Number State | MD
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