PM Kids Plus

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

Legal business name

PM KIDS PLUS

Practice address

603 Post Office Rd Ste 106
Waldorf, MD 20602-1914

Phone

(240) 585-7128

Fax

(240) 607-6749

NPI assigned

Oct 25, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Wali Gauvin, MD

Title

Co-Owner

Phone

(240) 585-7128

Specialties & licenses 5

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1144947797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 POST OFFICE RD STE 106",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021914",
            "telephone_number": "240-585-7128",
            "fax_number": "240-607-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 POST OFFICE RD STE 106",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021914",
            "telephone_number": "240-585-7128",
            "fax_number": "240-607-6749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PM KIDS PLUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "GAUVIN",
        "authorized_official_first_name": "WALI",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "240-585-7128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "961018900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmental - Behavioral Pediatrics Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Developmental - Behavioral Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; 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.