Provider Demographics
NPI:1992794051
Name:WILLOUGHBY BEACH PEDIATRICS P.A.
Entity type:Organization
Organization Name:WILLOUGHBY BEACH PEDIATRICS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAJLA
Authorized Official - Middle Name:AMETHA
Authorized Official - Last Name:ABDUR-RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-719-0063
Mailing Address - Street 1:7001 JOHNNYCAKE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2406
Mailing Address - Country:US
Mailing Address - Phone:410-719-0063
Mailing Address - Fax:410-719-6338
Practice Address - Street 1:7001 JOHNNYCAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2406
Practice Address - Country:US
Practice Address - Phone:410-719-0063
Practice Address - Fax:410-719-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty