Provider Demographics
NPI:1639457880
Name:ALLIANCE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ALLIANCE PEDIATRICS, LLC
Other - Org Name:ALLIANCE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-252-4105
Mailing Address - Street 1:220 MAIN STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:240-252-4105
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5471
Practice Address - Country:US
Practice Address - Phone:240-252-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04764103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty