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General NPI Number Information
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NPI Number | 1336453463
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Entity Type | Organization
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Legal Business Name | PEDS IN A POD PEDIATRICS LLC
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 1105 N POINT BLVD SUITE 306
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City | BALTIMORE
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State | MD
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Zip | 21224-3419
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Country | US
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Telephone | 410-285-5437
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Fax | 410-285-7333
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Provider Business Mailing Address
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Address Line | PO BOX 15444
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City | BALTIMORE
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State | MD
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Zip | 21220-0444
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Country | US
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Telephone | 410-285-5437
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Fax | 410-285-7333
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Authorized Official
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Title or Position | OWNER
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Name | STACEY L. EADIE
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Credential | D.O.
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Telephone | 443-421-6966
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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 | H0061035
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License Number State | MD
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