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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