Provider Demographics
NPI:1164070181
Name:XPRESS PEDIATRICS, LLC
Entity Type:Organization
Organization Name:XPRESS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-280-7924
Mailing Address - Street 1:7130 SANNER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1803
Mailing Address - Country:US
Mailing Address - Phone:240-280-7924
Mailing Address - Fax:
Practice Address - Street 1:11414 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1907
Practice Address - Country:US
Practice Address - Phone:240-280-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care