1063482610 NPI number — WHITE OAK PEDIATRICS DR BATTIATA & IMPEDUGLIA PA

Table of content: (NPI 1063482610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063482610 NPI number — WHITE OAK PEDIATRICS DR BATTIATA & IMPEDUGLIA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE OAK PEDIATRICS DR BATTIATA & IMPEDUGLIA PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063482610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11161 NEW HAMPSHIRE AVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-360-4446
Provider Business Mailing Address Fax Number:
410-360-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-360-4446
Provider Business Practice Location Address Fax Number:
410-360-4449
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFFER
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
NIEMEYER
Authorized Official Title or Position:
MEDICAL DIRECTOR PEDIATRIC PLACE UN
Authorized Official Telephone Number:
410-360-4446

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111071300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 952601300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880008100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 907009500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88056600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 670038100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 763500100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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