Provider Demographics
NPI:1568063758
Name:INNOVATIVE PEDIATRICS & MEDICINE
Entity Type:Organization
Organization Name:INNOVATIVE PEDIATRICS & MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAN
Authorized Official - Prefix:
Authorized Official - First Name:GIFTY
Authorized Official - Middle Name:
Authorized Official - Last Name:AFETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-337-8846
Mailing Address - Street 1:3921 FERRARA DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906
Mailing Address - Country:US
Mailing Address - Phone:301-337-8846
Mailing Address - Fax:301-946-0642
Practice Address - Street 1:3921 FERRARA DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:301-337-8846
Practice Address - Fax:301-946-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity MedicineGroup - Multi-Specialty