Dundalk Pediatric Associates, P. a.
Organization Active NPI Pediatrics Physician · Dundalk, MD
NPI 1003986704 · NPPES record last updated Jun 18, 2020
Key facts
- NPI
- 1003986704
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- DUNDALK PEDIATRIC ASSOCIATES, P. A.
- Practice address
- 1792 Merritt Blvd
Dundalk, MD 21222-3212 - Phone
- (410) 284-1133
- Fax
- (410) 284-3371
- NPI assigned
- Nov 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Sara Hinson
- Title
- Practice Admin
- Phone
- (410) 284-1133
Practitioners 7
-
Glinda Florendo, PAC
-
Anna Marie Deroose, CRNP, CPNP
-
Rachel Anne Barnes Dodge, MD, MPH
-
Cara Reske, CPNP
-
Angela Leasca Rizakos, CRNP
-
Kara Elizabeth Stripling, CRNP, MPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D0680922 | Dundalk Pediatric Associates PA | Provider-performed microscopy | Jun 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210811002262 | MD | Part B Supplier - Mass Immunization (Roster Biller Only) | 8628472784 | Practice locations: Dundalk, MD |
National Provider Directory
Locations
1792 Merritt Blvd
Dundalk, MD 21222
Phone (410) 284-1133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | MD | Yes |
Addresses
Primary practice location
1792 Merritt Blvd
Dundalk, MD 21222-3212
Mailing address
1792 Merritt Blvd
Dundalk, MD 21222-3212
Phone (410) 284-1133
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114551700 | Medicaid | MD |
Other providers in Dundalk, MD
- Esther Enid Douglas
- Dr. David M. Vieth 2, PC
- Drugs Cure Pharmacy & Surgicals LLC
- Drugstore Pharmacy, LLC
- Dundalk Medical Group LLC
- Courtney Nicole Dunnigan
- Dva Healthcare of Maryland LLC
- Brittany Ann Easter
- Edward Silverman DDS and Associates P.a.
- Lilian Ekwutife
All providers in Dundalk, MD · Pediatrics Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.