Provider Demographics
NPI:1689859373
Name:SANDY SPRING PEDIATRICS, LLC
Entity Type:Organization
Organization Name:SANDY SPRING PEDIATRICS, LLC
Other - Org Name:SANDY SPRING AFTER HOURS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT-MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-260-7777
Mailing Address - Street 1:17518 ASHTON FOREST TER
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-3009
Mailing Address - Country:US
Mailing Address - Phone:301-802-0813
Mailing Address - Fax:301-570-5710
Practice Address - Street 1:900 OLNEY SANDY SPRING RD
Practice Address - Street 2:SUITE A
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1317
Practice Address - Country:US
Practice Address - Phone:301-260-7777
Practice Address - Fax:301-260-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041884261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service