Southside Pediatrics & Adult Care LLC
Clinic/Center, Primary Care in Hagerstown, MD. Organization (NPI-2).
NPI number1669970067
StatusActive
Last updated in NPPESJun 9, 2022
Details
- NPI
- 1669970067
- Entity type
- Organization (NPI-2)
- Legal business name
- Southside Pediatrics & Adult Care LLC
- Organization subpart
- No
- Enumeration date
- Jan 31, 2018
- Certification date
- Jun 9, 2022
- Last updated
- Jun 9, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | 193525 | MD | Yes |
| 207Q00000X | Family Medicine | – | – |
Other names
- Christa L Martin Dba South Side Pediatrics (Former Legal Business Name)
Practice location
1185 Mount Aetna Rd Ste 200Hagerstown, MD 21740-6832
Phone 240-513-6300
Mailing address
1185 Mount Aetna Rd Ste 200Hagerstown, MD 21740-6832
Phone 240-513-6300
Authorized official
Christa Martin
Owner
2405136300
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