=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194721514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIGGS PEDIATRIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 01/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1835 UNIVERSITY BLVD E STE 316
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20783-4672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-434-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1835 UNIVERSITY BLVD E STE 316
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20783-4672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-434-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | FARIBA BAGHAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-434-3700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | D0044970
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------