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General NPI Number Information
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NPI Number | 1255157434
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Entity Type | Organization
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Legal Business Name | CLARKSBURG PEDIATRICS, L.L.C.
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 18506 OFFICE PARK DR
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20886-0585
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Country | US
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Telephone | 301-869-6461
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Fax | 301-869-8960
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Provider Business Mailing Address
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Address Line | 18506 OFFICE PARK DR
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20886-0585
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Country | US
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Telephone | 301-528-8181
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Fax | 301-869-8960
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Authorized Official
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Title or Position | CEO
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Name | ANWAR MASOOD
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Credential | MD
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Telephone | 301-528-8181
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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 |
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License Number State |
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