Provider Demographics
NPI:1912564626
Name:KENTLANDS PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KENTLANDS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-888-3609
Mailing Address - Street 1:108 KENT SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5650
Mailing Address - Country:US
Mailing Address - Phone:240-888-3609
Mailing Address - Fax:
Practice Address - Street 1:108 KENT SQUARE RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5650
Practice Address - Country:US
Practice Address - Phone:240-888-3609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty