THE VILLAGE PEDIATRIC & WELLNESS CENTER NPI 1174949358

NPI Information

NPI: 1174949358
Provider Name: THE VILLAGE PEDIATRIC & WELLNESS CENTER
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 21D2088072

Address:
50 W EDMONSTON DR STE 502
ROCKVILLE, MD
ZIP 20852
Phone: (301) 637-3005
Get Directions

THE VILLAGE PEDIATRIC & WELLNESS CENTER is a primary care clinic center in Rockville, MD. THE VILLAGE PEDIATRIC & WELLNESS CENTER NPI is 1174949358. The provider is registered as an organization entity type.

The provider's business location address is:

50 W EDMONSTON DR STE 502
ROCKVILLE, MD
ZIP 20852-222
Phone: (301) 637-3005
Fax: (866) 890-7221

The provider's authorized official is Monica Del Carmen Pourrat .
The authorized official title is Doctor and has the following contact phone number (301) 637-3005.

The CLIA number assigned to this NPI record is 21D2088072 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/11/2014 and was last updated on 3/11/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	D0062518	MARYLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	10234246	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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