Provider Demographics
NPI:1598373755
Name:PEDIATRIC DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:INDICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-358-1997
Mailing Address - Street 1:115 SUDBROOK LN STE A
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4184
Mailing Address - Country:US
Mailing Address - Phone:410-358-1997
Mailing Address - Fax:
Practice Address - Street 1:2250 N DRUID HILLS RD NE STE 265
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3141
Practice Address - Country:US
Practice Address - Phone:410-220-4306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE THERAPY SPOT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty