Provider Demographics
NPI:1588182240
Name:PEDIATRIC GASTROENTEROLOGY SPECIALISTS OF MARYLAND LLC
Entity Type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY SPECIALISTS OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-703-8767
Mailing Address - Street 1:6816 DEERPATH RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6200
Mailing Address - Country:US
Mailing Address - Phone:301-703-8767
Mailing Address - Fax:301-703-8766
Practice Address - Street 1:6816 DEERPATH RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6200
Practice Address - Country:US
Practice Address - Phone:301-703-8767
Practice Address - Fax:301-703-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty