Provider Demographics
NPI:1144565722
Name:INTEGRATIVE PEDIATRICS OF OLNEY INC
Entity Type:Organization
Organization Name:INTEGRATIVE PEDIATRICS OF OLNEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:301-752-0616
Mailing Address - Street 1:17810 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1038
Mailing Address - Country:US
Mailing Address - Phone:301-752-0616
Mailing Address - Fax:
Practice Address - Street 1:17810 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1038
Practice Address - Country:US
Practice Address - Phone:301-752-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00543282080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty