Provider Demographics
NPI: | 1922786490 |
---|---|
Name: | WHITE OAK PEDIATRICS DRS BATTIATA & IMPEDUGLIA PA |
Entity Type: | Organization |
Organization Name: | WHITE OAK PEDIATRICS DRS BATTIATA & IMPEDUGLIA PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GIOVANNI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | IMPEDUGLIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 301-681-7101 |
Mailing Address - Street 1: | 11161 NEW HAMPSHIRE AVE STE 301 |
Mailing Address - Street 2: | |
Mailing Address - City: | SILVER SPRING |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20904-2606 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11161 NEW HAMPSHIRE AVE STE 301 |
Practice Address - Street 2: | |
Practice Address - City: | SILVER SPRING |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20904-2606 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-681-7101 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | WHITE OAK PEDIATRICS DRS BATTIATA & IMPEDUGLIA PA |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-07-06 |
Last Update Date: | 2023-07-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family | Group - Multi-Specialty |