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General NPI Number Information
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NPI Number | 1427284595
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Entity Type | Organization
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Legal Business Name | GATEWAY PEDIATRICS, LLC
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1415 WESLEY DR
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City | SALISBURY
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State | MD
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Zip | 21801-7130
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Country | US
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Telephone | 410-912-7000
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Fax | 410-912-4202
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Provider Business Mailing Address
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Address Line | 1415 WESLEY DR
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City | SALISBURY
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State | MD
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Zip | 21801-7130
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Country | US
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Telephone | 410-912-7000
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Fax | 410-912-4202
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MELISSA J GRAVES
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Credential |
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Telephone | 410-912-7000
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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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