Provider Demographics
NPI:1912532490
Name:PEDIATRIC ENDOCRINOLOGY OF ANNAPOLIS
Entity Type:Organization
Organization Name:PEDIATRIC ENDOCRINOLOGY OF ANNAPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:PAGAN PARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-203-8202
Mailing Address - Street 1:2024 WEST ST STE 304
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3556
Mailing Address - Country:US
Mailing Address - Phone:443-203-8202
Mailing Address - Fax:443-203-8601
Practice Address - Street 1:2024 WEST ST STE 304
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3556
Practice Address - Country:US
Practice Address - Phone:443-203-8202
Practice Address - Fax:443-203-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty