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General NPI Number Information
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NPI Number | 1477036127
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Entity Type | Organization
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Legal Business Name | PANDA PEDIATRICS PLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 2440 M ST NW STE 422
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City | WASHINGTON
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State | DC
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Zip | 20037-1422
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Country | US
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Telephone | 703-585-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 M STREET NW, SUITE 422 STREET LINE 2
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City | WASHINGTON
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State | DC
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Zip | 20037
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Country | US
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Telephone | 703-585-0304
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY B. PULLMAN
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Credential | MD
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Telephone | 703-585-0304
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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 | MD15758
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License Number State | DC
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