Provider Demographics
NPI:1659541803
Name:THE PEDIATRIC CARE CENTER
Entity Type:Organization
Organization Name:THE PEDIATRIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:PEEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-564-5880
Mailing Address - Street 1:5612 SPRUCE TREE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1626
Mailing Address - Country:US
Mailing Address - Phone:301-564-5880
Mailing Address - Fax:301-564-5889
Practice Address - Street 1:5612 SPRUCE TREE AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1626
Practice Address - Country:US
Practice Address - Phone:301-564-5880
Practice Address - Fax:301-564-5889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PEDIATRIC CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty