NPIMap

Organization Active NPI

PG Communitypediatric and Adolescent Health Center Inc.

  • Pediatrics Physician
  • Cheverly, MD
National Provider Identifier
1275173031
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PG COMMUNITYPEDIATRIC AND ADOLESCENT HEALTH CENTER INC.
Practice address
6122 Landover Rd
Cheverly, MD 20785-1016
Phone
(301) 322-2411
NPI assigned
Jan 9, 2020
Last updated
Jan 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Dr. Modupe F Odunuga, MDNPI 1871588079
Title
President
Phone
(301) 322-2411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

6122 Landover Rd
Cheverly, MD 20785-1016

Mailing address

8420 Victory LN
Potomac, MD 20854-3562
Phone (301) 980-6417

National Provider Directory

National Provider Directory

Locations

6122 Landover Rd
Cheverly, MD 20785
Phone (301) 322-2411

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1275173031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8420 VICTORY LN",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543562",
            "telephone_number": "301-980-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6122 LANDOVER RD",
            "city": "CHEVERLY",
            "state": "MD",
            "postal_code": "207851016",
            "telephone_number": "301-322-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PG COMMUNITYPEDIATRIC AND ADOLESCENT HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "ODUNUGA",
        "authorized_official_first_name": "MODUPE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-322-2411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheverly, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; 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.