Provider Demographics
NPI:1912965997
Name:HAGERSTOWN PEDIATRICS
Entity Type:Organization
Organization Name:HAGERSTOWN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFAAT
Authorized Official - Middle Name:ULLAH
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-733-9335
Mailing Address - Street 1:363 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5747
Mailing Address - Country:US
Mailing Address - Phone:301-733-9335
Mailing Address - Fax:301-733-4191
Practice Address - Street 1:363 S CLEVELAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5747
Practice Address - Country:US
Practice Address - Phone:301-733-9335
Practice Address - Fax:301-733-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060377261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care