Provider Demographics
NPI:1093976813
Name:PEDIATRIC PROFESSIONALS, PC
Entity Type:Organization
Organization Name:PEDIATRIC PROFESSIONALS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:YARED
Authorized Official - Middle Name:
Authorized Official - Last Name:BELAI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-529-8832
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:STE 212
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-726-5800
Mailing Address - Fax:202-829-3753
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:STE 212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-726-5800
Practice Address - Fax:202-829-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400605400Medicaid
DC045523900Medicaid