Provider Demographics
NPI:1285098137
Name:MIDDLEBROOK PEDIATRICS LLC
Entity type:Organization
Organization Name:MIDDLEBROOK PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMENKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-330-4130
Mailing Address - Street 1:18528 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0586
Mailing Address - Country:US
Mailing Address - Phone:301-330-4130
Mailing Address - Fax:301-330-4150
Practice Address - Street 1:18528 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0586
Practice Address - Country:US
Practice Address - Phone:301-330-4130
Practice Address - Fax:301-330-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065257261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care