Provider Demographics
NPI:1821163676
Name:CHILDRENS PEDIATRICIANS & ASSOC
Entity Type:Organization
Organization Name:CHILDRENS PEDIATRICIANS & ASSOC
Other - Org Name:CHILDRENS NATIONAL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHULTS-SCARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-593-5566
Mailing Address - Street 1:10801 LOCKWOOD DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:301-593-5566
Mailing Address - Fax:301-593-3644
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-593-5566
Practice Address - Fax:301-593-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038838302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization