NPIMap

Organization Active NPI

Heritage Pediatrics, Inc.

  • Pediatrics Physician
  • Largo, MD
National Provider Identifier
1972903201
Registry record updated Jan 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D74464 Issued in MD
Legal business name
HERITAGE PEDIATRICS, INC.
Practice address
1450 Mercantile LN
Suite #217
Largo, MD 20774-5376
Phone
(301) 341-5000
Fax
(301) 341-5001
NPI assigned
Aug 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2022

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

Authorized official

Name
Dr. Babajide Eyitayo Faditan, M.DNPI 1699087403
Title
President
Phone
(301) 341-5000

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 D74464 MD Primary

Addresses

Primary practice location

1450 Mercantile LN
Suite #217
Largo, MD 20774-5376

Mailing address

PO Box 7598
Largo, MD 20792-7598
Phone (301) 341-5000

Other identifiers 2

IdentifierTypeStateIssuer
1699087403OtherMDINDIVIDUAL NPI
378100300MedicaidMD

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
21D2095047Heritage Pediatrics, Inc1450 Mercantile Lane Suite 217, Largo, MD 20774Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642809600000",
    "number": "1972903201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7598",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207927598",
            "telephone_number": "301-341-5000",
            "fax_number": "301-341-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 MERCANTILE LN",
            "address_2": "SUITE #217",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207745376",
            "telephone_number": "301-341-5000",
            "fax_number": "301-341-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2022-01-22",
        "certification_date": "2022-01-22",
        "status": "A",
        "authorized_official_last_name": "FADITAN",
        "authorized_official_first_name": "BABAJIDE",
        "authorized_official_middle_name": "EYITAYO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-341-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D74464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1699087403",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378100300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2022; 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.