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General NPI Number Information
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NPI Number | 1992215081
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Entity Type | Organization
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Legal Business Name | P4 PHYSICIANS PC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8000 VIRGINIA MANOR RD STE 170
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City | BELTSVILLE
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State | MD
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Zip | 20705-4230
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Country | US
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Telephone | 301-715-3805
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Fax | 301-715-3805
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Provider Business Mailing Address
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Address Line | 8000 VIRGINIA MANOR RD STE 170
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City | BELTSVILLE
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State | MD
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Zip | 20705-4230
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Country | US
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Telephone | 301-715-3805
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHEELA REDDY
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Credential | ED. D
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Telephone | 301-785-7991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04313
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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