1275173031 NPI number — PG COMMUNITYPEDIATRIC AND ADOLESCENT HEALTH CENTER INC.

Table of content: (NPI 1275173031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275173031 NPI number — PG COMMUNITYPEDIATRIC AND ADOLESCENT HEALTH CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PG COMMUNITYPEDIATRIC AND ADOLESCENT HEALTH CENTER INC.
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:
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:
1275173031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8420 VICTORY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-3562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-980-6417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6122 LANDOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEVERLY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-322-2411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ODUNUGA
Authorized Official First Name:
MODUPE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-322-2411

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com