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General NPI Number Information
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NPI Number | 1891001996
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Entity Type | Organization
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Legal Business Name | LA PLATA PEDIATRICS & FAMILY HEALTH, LLC
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 103 CENTENNIAL ST SUITE B
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City | LA PLATA
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State | MD
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Zip | 20646-5984
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Country | US
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Telephone | 301-643-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 103 CENTENNIAL ST STE B
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City | LA PLATA
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State | MD
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Zip | 20646-5985
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Country | US
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Telephone | 301-934-9111
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Fax |
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Authorized Official
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Title or Position | OWNER AND NURSE PRACTITIONER
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Name | JAMIE REIDY
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Credential | CRNP
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Telephone | 13-934-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | R162903
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | R162903
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License Number State | MD
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