Provider Demographics
NPI:1609407592
Name:LOVELIGHT PEDIATRICS, LLC
Entity Type:Organization
Organization Name:LOVELIGHT PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:SISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-533-7060
Mailing Address - Street 1:607 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-3734
Mailing Address - Country:US
Mailing Address - Phone:301-533-7060
Mailing Address - Fax:877-766-4406
Practice Address - Street 1:607 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-3734
Practice Address - Country:US
Practice Address - Phone:301-533-7060
Practice Address - Fax:877-766-4406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVELIGHT PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty