1588622302 NPI number — SOUTHERN MARYLAND PEDIATRICS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588622302 NPI number — SOUTHERN MARYLAND PEDIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MARYLAND PEDIATRICS LLC
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:
1588622302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7501 SURRATTS RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-877-4616
Provider Business Mailing Address Fax Number:
301-877-2695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7503 SURRATTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-3358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-870-7001
Provider Business Practice Location Address Fax Number:
301-870-6697
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAKIA
Authorized Official First Name:
ASEK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
301-877-4616

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)





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