Provider Demographics
NPI:1255424362
Name:GREENBELT PEDIATRICS
Entity type:Organization
Organization Name:GREENBELT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKOS
Authorized Official - Middle Name:
Authorized Official - Last Name:YIBAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-3021
Mailing Address - Street 1:7313 B HANOVER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-220-3021
Mailing Address - Fax:301-982-7875
Practice Address - Street 1:7313 B HANOVER PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-220-3021
Practice Address - Fax:301-982-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty