Organization
PREMIER PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON LANE WEST M.D. (PRESIDENT)
(410) 761-7305
Entity
Organization
Contact information
Practice address
7310 RITCHIE HWY, SUITE 516, GLEN BURNIE, MD 21061
(410) 761-7305
(410) 761-7387
Mailing address
7310 RITCHIE HWY, SUITE 516, GLEN BURNIE, MD 21061
(410) 761-7305
(410) 761-7387
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D0057446
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
776200300
—
MD
Enumeration date
01/03/2014
Last updated
01/03/2014
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