Provider Demographics
NPI:1720050149
Name:DAYSPRING PEDIATRICS, LLC
Entity type:Organization
Organization Name:DAYSPRING PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:APIADO
Authorized Official - Last Name:EBREO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-658-1300
Mailing Address - Street 1:120 RYAN DR
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-1840
Mailing Address - Country:US
Mailing Address - Phone:410-658-1300
Mailing Address - Fax:410-658-1828
Practice Address - Street 1:120 RYAN DR
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-1840
Practice Address - Country:US
Practice Address - Phone:410-658-1300
Practice Address - Fax:410-658-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty