Provider Demographics
NPI:1750632477
Name:PARK PLACE PRIMARY CARE LLC
Entity Type:Organization
Organization Name:PARK PLACE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBIADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-776-6121
Mailing Address - Street 1:601 7TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4003
Mailing Address - Country:US
Mailing Address - Phone:301-776-6121
Mailing Address - Fax:301-776-3860
Practice Address - Street 1:601 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4003
Practice Address - Country:US
Practice Address - Phone:301-776-6121
Practice Address - Fax:301-776-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty