Ettienne'S Premier Pediatric Care LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D0046373 Issued in MD

Legal business name

ETTIENNE'S PREMIER PEDIATRIC CARE LLC

Practice address

2905 Mitchellville Rd
Ste 115
Bowie, MD 20716-1385

Phone

(301) 390-7960

Fax

(301) 218-2800

NPI assigned

May 17, 2007

Organization subpart

No

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

Authorized official

Name

Suzette Scipio Ettienne, M.D.

Title

Medical Director

Phone

(301) 390-7960

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7993/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Suzette Scipio - Ettienne, MD

  • Pediatrics Physician
  • Bowie, MD
  • NPI 1730252594
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1841408697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 MITCHELLVILLE RD",
            "address_2": "STE 115",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161385",
            "telephone_number": "301-390-7960",
            "fax_number": "301-218-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 MITCHELLVILLE RD",
            "address_2": "STE 115",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161385",
            "telephone_number": "301-390-7960",
            "fax_number": "301-218-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETTIENNE'S PREMIER PEDIATRIC CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "ETTIENNE",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_middle_name": "SCIPIO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-390-7960",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0046373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363101000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alemawung Abondem Etiendem
• Lerahzoah Etiendem
• Valentine B Etiendem
• Stephanie Etienne, LMSW
• Linda S Etih
• Eursdale Companies, LLC
• Melvina Evans-Smith, LCPC
• Evolve Therapeutic Health and Wellness Services
• Evolve Therapuetic Behavioral Health and Wellness Services
• Evolve Therapuetic Health and Wellness Services

• Pediatrics Physician in Bowie, MD
• Providers in Bowie, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.