Provider Demographics
NPI:1730469065
Name:BRIGHT FUTURE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BRIGHT FUTURE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMOON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-278-5286
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19903-1082
Mailing Address - Country:US
Mailing Address - Phone:856-278-5286
Mailing Address - Fax:
Practice Address - Street 1:938 S BRADFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4140
Practice Address - Country:US
Practice Address - Phone:856-278-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006010208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEH30248OtherBCBS