Med-Ped Healthcare, LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

D0053745 Issued in MD

Legal business name

MED-PED HEALTHCARE, LLC

Practice address

4701 Melbourne PL
College Park, MD 20740-2540

Phone

(301) 345-4400

Fax

(301) 345-6200

NPI assigned

Apr 16, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jamal Fadul, M.D.

Title

Owner

Phone

(301) 345-4400

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1114314150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 MELBOURNE PLACE",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "20740",
            "telephone_number": "301-345-4400",
            "fax_number": "301-345-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 MELBOURNE PL",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207402540",
            "telephone_number": "301-345-4400",
            "fax_number": "301-345-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-PED HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "FADUL",
        "authorized_official_first_name": "JAMAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-345-4400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MD",
            "license": "D0053745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G00445",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in College Park, MD
• Providers in College Park, MD by specialty
• Preferred Provider Organization in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.