Provider Demographics
NPI:1336453463
Name:PEDS IN A POD PEDIATRICS LLC
Entity Type:Organization
Organization Name:PEDS IN A POD PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EADIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-421-6966
Mailing Address - Street 1:PO BOX 15444
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-0444
Mailing Address - Country:US
Mailing Address - Phone:410-285-5437
Mailing Address - Fax:410-285-7333
Practice Address - Street 1:1105 N POINT BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3419
Practice Address - Country:US
Practice Address - Phone:410-285-5437
Practice Address - Fax:410-285-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0061035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCMT7SLOtherCAREFIRST
DCX026 0001OtherCAREFIRST