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Organization
PM KIDS PLUS
Active
Organization
PM KIDS PLUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALI GAUVIN MD (CO-OWNER)
(240) 585-7128
Entity
Organization
Contact information
Practice address
603 POST OFFICE RD STE 106, WALDORF, MD 20602-1914
(240) 585-7128
(240) 607-6749
Mailing address
603 POST OFFICE RD STE 106, WALDORF, MD 20602-1914
(240) 585-7128
(240) 607-6749
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
235Z00000X
Speech-Language Pathologist
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
961018900
—
MD
Enumeration date
10/25/2022
Last updated
11/01/2022
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