Provider Demographics
NPI:1285757971
Name:PRIMECARE PEDIATRICS
Entity type:Organization
Organization Name:PRIMECARE PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-554-2919
Mailing Address - Street 1:201 E UNIVERSITY PKWY
Mailing Address - Street 2:33RD ST. PROF., BLDG, SUITE 233
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-2919
Mailing Address - Fax:410-554-2570
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:33RD ST. PROF. BLDG., SUITE 233
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2919
Practice Address - Fax:410-554-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1407823776OtherGR. GOPAL INDETUAL NPI #