Provider Demographics
NPI:1598779886
Name:THE PEDIATRIC GROUP, LLP
Entity Type:Organization
Organization Name:THE PEDIATRIC GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-721-2273
Mailing Address - Street 1:2225 DEFENSE HWY STE E
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2772 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035-1228
Practice Address - Country:US
Practice Address - Phone:410-451-2116
Practice Address - Fax:410-721-2656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PEDIATRIC GROUP, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-29
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD729111600Medicaid
MD729111600Medicaid