Provider Demographics
NPI:1831507847
Name:PEDIATRIC CARE
Entity type:Organization
Organization Name:PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHOLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-434-8800
Mailing Address - Street 1:7505 NEW HAMPSHIRE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7505 NEW HAMPSHIRE AVE STE 302
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6972
Practice Address - Country:US
Practice Address - Phone:301-434-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61511208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty