Provider Demographics
NPI:1588622302
Name:SOUTHERN MARYLAND PEDIATRICS LLC
Entity Type:Organization
Organization Name:SOUTHERN MARYLAND PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ASEK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-877-4616
Mailing Address - Street 1:7501 SURRATTS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3362
Mailing Address - Country:US
Mailing Address - Phone:301-877-4616
Mailing Address - Fax:301-877-2695
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-870-7001
Practice Address - Fax:301-870-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTAX ID NUMBER