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Organization
ETTIENNE'S PREMIER PEDIATRIC CARE LLC
Active
Organization
ETTIENNE'S PREMIER PEDIATRIC CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZETTE SCIPIO ETTIENNE M.D. (MEDICAL DIRECTOR)
(301) 390-7960
Entity
Organization
Contact information
Practice address
2905 MITCHELLVILLE RD, STE 115, BOWIE, MD 20716-1385
(301) 390-7960
(301) 218-2800
Mailing address
2905 MITCHELLVILLE RD, STE 115, BOWIE, MD 20716-1385
(301) 390-7960
(301) 218-2800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D0046373
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363101000
—
MD
Enumeration date
05/17/2007
Last updated
12/12/2013
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