Provider Demographics
NPI:1912043936
Name:PEDIATRIC PARTNERS LLC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-638-0537
Mailing Address - Street 1:4C NORTH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2330
Mailing Address - Country:US
Mailing Address - Phone:410-638-0537
Mailing Address - Fax:410-638-0282
Practice Address - Street 1:8600 LASALLE RD
Practice Address - Street 2:POTOMAC BUILDING SUITE 105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2001
Practice Address - Country:US
Practice Address - Phone:410-823-5232
Practice Address - Fax:410-296-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00281222080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD78076Medicare UPIN