MEDICARE: DAYSPRING 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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1720050149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYSPRING PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	120 RYAN DR
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-1840
Country	:	US
Telephone Number	:	410-658-1300
Fax Number	:	410-658-1828

Provider Business Practice Location Address
First Line	:	120 RYAN DR
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-1840
Country	:	US
Telephone Number	:	410-658-1300
Fax Number	:	410-658-1828

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REYNALDO APIADO EBREO
Credential	:	M.D.
Telephone Number	:	410-658-1300

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	08/22/2020

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