Jean Wahyudiati Pribadi, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D30510 Issued in MD

Practice address

10632 Little Patuxent Parkway
Suite 111
Columbia, MD 21044-6212

Phone

(410) 997-9751

Fax

(410) 997-9763

NPI assigned

Oct 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922196922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10632 LITTLE PATUXENT PARKWAY",
            "address_2": "SUITE 111",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210446212",
            "telephone_number": "410-997-9751",
            "fax_number": "410-997-9763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10632 LITTLE PATUXENT PARKWAY",
            "address_2": "SUITE 111",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210446212",
            "telephone_number": "410-997-9751",
            "fax_number": "410-997-9763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIBADI",
        "first_name": "JEAN",
        "middle_name": "WAHYUDIATI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D30510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Preston, RN
• Kaitlyn Rose Preston, PTA
• Akesha Atina Prettymen
• Prevention &Management Outreach Clinic Inc.
• Quasherra Prevo
• Kenya Price-Johnson
• Andreona C Price, LCSW
• Ebony Makeshia Price
• Lauren Elizabeth Price, LCSW-C
• Michelle Y Price, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.