Organization
DAVIDSONVILLE PEDIATRICS
Active
Organization
DAVIDSONVILLE PEDIATRICS
Active
Other names
DAVIDSONVILLE PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
2772 RUTLAND RD, DAVIDSONVILLE, MD 21035-1228
(410) 269-7828
(410) 269-0510
Mailing address
2772 RUTLAND RD, DAVIDSONVILLE, MD 21035-1228
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
D0013889
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124410
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/24/2006
Last updated
08/22/2020
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