Provider Demographics
NPI:1285065904
Name:PADONIA PEDIATRICS & MEDICINE, LLC
Entity type:Organization
Organization Name:PADONIA PEDIATRICS & MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-841-7668
Mailing Address - Street 1:2405 YORK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2256
Mailing Address - Country:US
Mailing Address - Phone:443-841-7668
Mailing Address - Fax:443-841-7644
Practice Address - Street 1:2405 YORK RD STE 103
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2256
Practice Address - Country:US
Practice Address - Phone:443-841-7668
Practice Address - Fax:443-841-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD085504960Medicaid