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General NPI Number Information
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NPI Number | 1568109189
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Entity Type | Organization
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Legal Business Name | MEADOWRIDGE PEDIATRICS, LLC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 6020 MEADOWRIDGE CENTER DR STE P1
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City | ELKRIDGE
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State | MD
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Zip | 21075-6528
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Country | US
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Telephone | 443-936-8821
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Fax |
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Provider Business Mailing Address
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Address Line | 6020 MEADOWRIDGE CENTER DR STE P1
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City | ELKRIDGE
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State | MD
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Zip | 21075-6528
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Country | US
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Telephone | 443-492-9466
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. CELINE CHANG
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Credential | CPNP-PC
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Telephone | 443-492-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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