Provider Demographics
NPI:1831131556
Name:CHILDREN FIRST PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN FIRST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-990-1664
Mailing Address - Street 1:2301 RESEARCH BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3204
Mailing Address - Country:US
Mailing Address - Phone:301-990-1664
Mailing Address - Fax:301-990-0471
Practice Address - Street 1:2301 RESEARCH BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3204
Practice Address - Country:US
Practice Address - Phone:301-990-1664
Practice Address - Fax:301-990-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047666208000000X
MDD0067397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024397360Medicaid