MEDICARE: PADONIA PEDIATRICS & MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285065904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PADONIA PEDIATRICS & MEDICINE, LLC

Provider Business Mailing Address
First Line	:	2405 YORK RD
Second Line	:	SUITE 103
City	:	TIMONIUM
State	:	MD
Zip	:	21093-2256
Country	:	US
Telephone Number	:	443-841-7668
Fax Number	:	443-841-7644

Provider Business Practice Location Address
First Line	:	2405 YORK RD STE 103
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-2256
Country	:	US
Telephone Number	:	443-841-7668
Fax Number	:	443-841-7644

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE ALICIA KRAMER
Credential	:	M.D.
Telephone Number	:	443-841-7668

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	06/06/2017

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