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General NPI Number Information
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NPI Number | 1265256531
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Entity Type | Organization
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Legal Business Name | WESTERN MARYLAND PEDIATRICS
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 13308 WINCHESTER ROAD
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City | LAVALE
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State | MD
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Zip | 21502
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Country | US
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Telephone | 301-707-7270
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Fax |
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Provider Business Mailing Address
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Address Line | 13210 GROWDENVALE DRIVE NE
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City | CUMBERLAND
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State | MD
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Zip | 21502
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Country | US
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Telephone | 301-707-7270
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Fax |
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Authorized Official
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Title or Position | NEONATAL, PEDIATRIC NURSE PRACTITI
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Name | JACQUELYN PETRELLA BAUER
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Credential | CRNP
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Telephone | 301-707-7270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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