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General NPI Number Information
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NPI Number | 1982459715
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PEDIATRIC CARE LLC
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 9400 LIVINGSTON RD STE 320
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4966
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Country | US
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Telephone | 202-320-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 9400 LIVINGSTON RD STE 320
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4966
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RUTH KANTHULA
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Credential | MD
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Telephone | 202-320-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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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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