Provider Demographics
NPI:1023558384
Name:FORT WASHINGTON PARK PEDIATRICS P.C.
Entity Type:Organization
Organization Name:FORT WASHINGTON PARK PEDIATRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:914-316-7066
Mailing Address - Street 1:6830 HOSPITAL DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4373
Mailing Address - Country:US
Mailing Address - Phone:410-238-5390
Mailing Address - Fax:410-238-5396
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:410-238-5390
Practice Address - Fax:410-238-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty