Organization
MED-PED HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMAL FADUL M.D. (OWNER)
(301) 345-4400
Entity
Organization
Contact information
Practice address
4701 MELBOURNE PL, COLLEGE PARK, MD 20740-2540
(301) 345-4400
(301) 345-6200
Mailing address
4701 MELBOURNE PLACE, COLLEGE PARK, MD 20740
(301) 345-4400
(301) 345-6200
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
D0053745
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G00445
MEDICARE PTAN
MD
Enumeration date
04/16/2015
Last updated
04/16/2015
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