Provider Demographics
NPI:1588551402
Name:PRIMARY PEDIATRICS
Entity type:Organization
Organization Name:PRIMARY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-776-8000
Mailing Address - Street 1:9811 MALLARD DRIVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-776-8000
Mailing Address - Fax:301-776-8052
Practice Address - Street 1:17001 SCIENCE DRIVE
Practice Address - Street 2:SUITE #116
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-464-2300
Practice Address - Fax:301-464-9604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIVIA MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD910111000Medicaid