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Organization
CIVISTA PEDIATRIC HOSPITALIST GROUP
Active
Organization
CIVISTA PEDIATRIC HOSPITALIST GROUP
Active
Parent organization
CIVISTA MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
CIVISTA MEDICAL CENTER
Authorized official
MR. ERIK BOAS (CHIEF FINANCIAL OFFICER)
(301) 609-4130
Entity
Organization
Contact information
Practice address
5 GARRETT AVE, LA PLATA, MD 20646-5960
(301) 609-4000
Mailing address
5 GARRETT AVE, PO BOX 1070, LA PLATA, MD 20646-5960
(301) 609-4000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
10/14/2009
Last updated
10/22/2009
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