Provider Demographics
NPI:1750407862
Name:THE PEDIATRIC AND ADOLESCENT CENTER, LLC
Entity type:Organization
Organization Name:THE PEDIATRIC AND ADOLESCENT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GALANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-218-3700
Mailing Address - Street 1:12164 CENTRAL AVE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1944
Mailing Address - Country:US
Mailing Address - Phone:301-218-3700
Mailing Address - Fax:301-218-3909
Practice Address - Street 1:12164 CENTRAL AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1944
Practice Address - Country:US
Practice Address - Phone:301-218-3700
Practice Address - Fax:301-218-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00508192080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty