Provider Demographics
NPI:1710139316
Name:WHITE OAK PEDIATRICS
Entity Type:Organization
Organization Name:WHITE OAK PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:IMPEDUGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-681-7101
Mailing Address - Street 1:11161 NEW HAMPSHIRE AVE
Mailing Address - Street 2:#301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-681-7101
Mailing Address - Fax:301-681-8127
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE.
Practice Address - Street 2:#301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-681-7101
Practice Address - Fax:301-681-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty