Pediatric Clinic, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRIC CLINIC, LLC

Practice address

324 E Antietam St
Suite 200
Hagerstown, MD 21740-5754

Phone

(301) 733-2890

Fax

(301) 733-2917

NPI assigned

May 16, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jackson Maina Nganga, M.D.

Title

Medical Director

Phone

(301) 733-2890

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1861785412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 E ANTIETAM ST",
            "address_2": "SUITE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405754",
            "telephone_number": "301-733-2890",
            "fax_number": "301-733-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 E ANTIETAM ST",
            "address_2": "SUITE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405754",
            "telephone_number": "301-733-2890",
            "fax_number": "301-733-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-16",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "NGANGA",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_middle_name": "MAINA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-733-2890",
        "authorized_official_name_prefix": "Dr.",
        "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": []
}

• Jeffrey Pearlman, DDS
• Nancy Pearson
• Amber Nichole Peck, CRNP
• Holly Ann Peck, PTA
• Amanda Pedersen, MA, BCBA, LBA
• Pediatric TLC, Inc
• Pediatrix Medical Group of the Mid-Atlantic PC
• Pediatrix of Maryland PA
• Tamra Peeke, DDS
• Jasmine Ophelia Pega, CRNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.