Provider Demographics
NPI:1710174115
Name:FOREST HILL PEDIATRICS
Entity Type:Organization
Organization Name:FOREST HILL PEDIATRICS
Other - Org Name:GRACE KOBUSINGYE MD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBUSINGYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-420-1743
Mailing Address - Street 1:2005 ROCK SPRING RD
Mailing Address - Street 2:SUITE#1
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2621
Mailing Address - Country:US
Mailing Address - Phone:410-420-1743
Mailing Address - Fax:
Practice Address - Street 1:2005 ROCK SPRING RD
Practice Address - Street 2:SUITE#1
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2621
Practice Address - Country:US
Practice Address - Phone:410-420-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty