Organization
HERITAGE PEDIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BABAJIDE EYITAYO FADITAN M.D (PRESIDENT)
(301) 341-5000
Entity
Organization
Contact information
Practice address
1450 MERCANTILE LN, SUITE #217, LARGO, MD 20774-5376
(301) 341-5000
(301) 341-5001
Mailing address
PO BOX 7598, LARGO, MD 20792-7598
(301) 341-5000
(301) 341-5001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D74464
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699087403
INDIVIDUAL NPI
MD
05
—
378100300
—
MD
Enumeration date
08/22/2014
Last updated
01/22/2022
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