Provider Demographics
NPI:1013386846
Name:RIVERDALE PARK PEDIATRICS PC
Entity Type:Organization
Organization Name:RIVERDALE PARK PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-277-2779
Mailing Address - Street 1:6103 BALTIMORE AVE
Mailing Address - Street 2:SUITE T-1
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1966
Mailing Address - Country:US
Mailing Address - Phone:301-277-2779
Mailing Address - Fax:301-277-6947
Practice Address - Street 1:6103 BALTIMORE AVE
Practice Address - Street 2:SUITE T-1
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1966
Practice Address - Country:US
Practice Address - Phone:301-277-2779
Practice Address - Fax:301-277-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty