Provider Demographics
NPI:1255157434
Name:CLARKSBURG PEDIATRICS, L.L.C.
Entity type:Organization
Organization Name:CLARKSBURG PEDIATRICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-528-8181
Mailing Address - Street 1:18506 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0585
Mailing Address - Country:US
Mailing Address - Phone:301-528-8181
Mailing Address - Fax:301-869-8960
Practice Address - Street 1:18506 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0585
Practice Address - Country:US
Practice Address - Phone:301-869-6461
Practice Address - Fax:301-869-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty