NPIMap

Organization Active NPI

Laurel Pine Pediatrics LLC

  • Pediatrics Physician
  • Laurel, MD
National Provider Identifier
1982986519
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D41251 Issued in MD
Legal business name
LAUREL PINE PEDIATRICS LLC
Practice address
14333 Laurel Bowie Rd
Suite 206
Laurel, MD 20708
Phone
(301) 362-0506
Fax
(301) 362-6711
NPI assigned
Sep 9, 2011
Organization subpart
Yes
Parent organization
LAUREL PINE PEDIATRICS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Authorized official

Name
Dr. Wondu T. Wossen, M.D.NPI 1164474391
Title
Physician
Phone
(301) 362-0506

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 D41251 MD Primary

Addresses

Primary practice location

14333 Laurel Bowie Rd
Suite 206
Laurel, MD 20708

Mailing address

14333 Laurel Bowie Rd
Suite 206
Laurel, MD 20708
Phone (301) 362-0506

Other identifiers 1

IdentifierTypeStateIssuer
649741100MedicaidMD

National Provider Directory

National Provider Directory
Part of
Laurel Pine Pediatrics LLC

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1982986519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14333 LAUREL BOWIE RD",
            "address_2": "SUITE 206",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "20708",
            "telephone_number": "301-362-0506",
            "fax_number": "301-362-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14333 LAUREL BOWIE RD",
            "address_2": "SUITE 206",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "20708",
            "telephone_number": "301-362-0506",
            "fax_number": "301-362-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREL PINE PEDIATRICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAUREL PINE PEDIATRICS LLC",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "WOSSEN",
        "authorized_official_first_name": "WONDU",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "301-362-0506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D41251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "649741100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.