Provider Demographics
NPI:1568109189
Name:MEADOWRIDGE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:MEADOWRIDGE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP-PC
Authorized Official - Phone:443-492-9466
Mailing Address - Street 1:6020 MEADOWRIDGE CENTER DR STE P1
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6528
Mailing Address - Country:US
Mailing Address - Phone:443-492-9466
Mailing Address - Fax:
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR STE P1
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6528
Practice Address - Country:US
Practice Address - Phone:443-936-8821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty