Provider Demographics
NPI:1073397485
Name:ROCK CREEK PEDIATRICS LLC
Entity Type:Organization
Organization Name:ROCK CREEK PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:FAUST
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:202-258-1025
Mailing Address - Street 1:12701 BRUSHWOOD TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1003
Mailing Address - Country:US
Mailing Address - Phone:202-258-1025
Mailing Address - Fax:
Practice Address - Street 1:9715 MEDICAL CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3320
Practice Address - Country:US
Practice Address - Phone:202-258-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty