MEDICARE: NORTH PARK PEDIATRICS, 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	2080A0000X	Pediatric Adolescent Medicine Physician	D0053392	MD

General Provider Information

NPI Number	:	1447371885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PARK PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	4C NORTH AVE
Second Line	:	SUITE 403
City	:	BEL AIR
State	:	MD
Zip	:	21014-2330
Country	:	US
Telephone Number	:	410-838-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	4C NORTH AVE
Second Line	:	SUITE 403
City	:	BEL AIR
State	:	MD
Zip	:	21014-2330
Country	:	US
Telephone Number	:	410-838-9142
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SCOTT KENNETH WINIECKI
Credential	:	MD
Telephone Number	:	410-838-0343

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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