Provider Demographics
NPI:1649235888
Name:OPAL COURT PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:OPAL COURT PEDIATRICS, P.A.
Other - Org Name:DRS WEISS & BECKER PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ATCHUTHANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-791-6666
Mailing Address - Street 1:1141 OPAL COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5976
Mailing Address - Country:US
Mailing Address - Phone:301-791-6666
Mailing Address - Fax:301-791-4549
Practice Address - Street 1:1141 OPAL COURT
Practice Address - Street 2:SUITE A
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5976
Practice Address - Country:US
Practice Address - Phone:301-791-6666
Practice Address - Fax:301-791-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD757481900Medicaid