| La Plata Pediatrics & Family Health, Llc | |
|
103 Centennial St Suite B La Plata MD 20646-5984 | |
| (301) 643-8127 | |
| Not Available |
| Full Name | La Plata Pediatrics & Family Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 Centennial St, La Plata, Maryland |
| Authorized Official Name and Position | Jamie Reidy (OWNER AND NURSE PRACTITIONER) |
| Authorized Official Contact | 0139349111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Plata Pediatrics & Family Health, Llc 103 Centennial St Ste B La Plata MD 20646-5985 Ph: (301) 934-9111 | La Plata Pediatrics & Family Health, Llc 103 Centennial St Suite B La Plata MD 20646-5984 Ph: (301) 643-8127 |
| NPI Number | 1891001996 |
|---|---|
| Provider Enumeration Date | 08/26/2010 |
| Last Update Date | 07/21/2023 |
| Certification Date | 07/21/2023 |
| Medicare PECOS PAC ID | 8022207059 |
|---|---|
| Medicare Enrollment ID | O20110106000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891001996 | NPI | - | NPPES |
| 033338700 | Medicaid | MD |
| Provider Name | Jamie Lee Reidy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508185505 PECOS PAC ID: 9931398963 Enrollment ID: I20110107000042 |
| Provider Name | Hajr Abdul Qudduws Muhammad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740789791 PECOS PAC ID: 4688920861 Enrollment ID: I20180629002029 |
| Provider Name | Christina Licalzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710451299 PECOS PAC ID: 0446683072 Enrollment ID: I20191211003101 |
| Provider Name | Constance Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386118867 PECOS PAC ID: 7012340664 Enrollment ID: I20191212000477 |
| Provider Name | Kimberly Ann Garner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790271401 PECOS PAC ID: 5597181263 Enrollment ID: I20200812003416 |
| Provider Name | Alyson Anne Lowery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659988962 PECOS PAC ID: 0547673964 Enrollment ID: I20210104001098 |
| Provider Name | Jennifer Blansett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982219739 PECOS PAC ID: 3779996996 Enrollment ID: I20210107002297 |
| Provider Name | Ryan James Hess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144998741 PECOS PAC ID: 3476944596 Enrollment ID: I20211229000169 |
| Provider Name | Jamie Lea Welch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447936125 PECOS PAC ID: 5890159529 Enrollment ID: I20230914001006 |
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