Provider Demographics
NPI:1891001996
Name:LA PLATA PEDIATRICS & FAMILY HEALTH, LLC
Entity type:Organization
Organization Name:LA PLATA PEDIATRICS & FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REIDY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:013-934-9111
Mailing Address - Street 1:103 CENTENNIAL ST STE B
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5985
Mailing Address - Country:US
Mailing Address - Phone:301-934-9111
Mailing Address - Fax:
Practice Address - Street 1:103 CENTENNIAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5984
Practice Address - Country:US
Practice Address - Phone:301-643-8127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
MDR162903261QM2500X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033338700Medicaid