NPIMap

Organization Active NPI

Kenwood Pediatrics, LLC

  • Pediatrics Physician
  • Bethesda, MD
National Provider Identifier
1790020642
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KENWOOD PEDIATRICS, LLC
Practice address
5301 Westbard Cir
Suite 3
Bethesda, MD 20816-1401
Phone
(301) 654-6303
Fax
(301) 654-6304
NPI assigned
Dec 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Authorized official

Name
Nadine Z. Idriss, M.D.NPI 1295995991
Title
Owner
Phone
(301) 654-6303

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

5301 Westbard Cir
Suite 3
Bethesda, MD 20816-1401

Mailing address

5301 Westbard Cir
Suite 3
Bethesda, MD 20816-1401
Phone (301) 654-6303

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0673684Kenwood Pediatrics DRS Idriss5301 Westbard Circle Suite #3, Bethesda, MD 20816AccreditationJul 29, 2027

National Provider Directory

National Provider Directory

Locations

5301 Westbard Cir
Bethesda, MD 20816
Phone (301) 654-0900

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1790020642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 WESTBARD CIR",
            "address_2": "SUITE 3",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208161401",
            "telephone_number": "301-654-6303",
            "fax_number": "301-654-6304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 WESTBARD CIR",
            "address_2": "SUITE 3",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208161401",
            "telephone_number": "301-654-6303",
            "fax_number": "301-654-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENWOOD PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-04",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "IDRISS",
        "authorized_official_first_name": "NADINE",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-654-6303",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.