Provider Demographics
NPI:1922881127
Name:PEDIATRIC WELLNESS CENTER PA
Entity Type:Organization
Organization Name:PEDIATRIC WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS-MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-324-0100
Mailing Address - Street 1:9560 PENNSYLVANIA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3768
Mailing Address - Country:US
Mailing Address - Phone:301-324-0100
Mailing Address - Fax:240-219-3125
Practice Address - Street 1:9560 PENNSYLVANIA AVE STE 106
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3768
Practice Address - Country:US
Practice Address - Phone:301-324-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty