| Laurel Pediatric And Teen Medical Center | |
|
2014 S Tollgate Rd Suite 200 Bel Air MD 21015-5903 | |
| (410) 569-9533 | |
| (410) 569-1254 |
| Full Name | Laurel Pediatric And Teen Medical Center |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2014 S Tollgate Rd, Bel Air, Maryland |
| Authorized Official Name and Position | Generosa Cruz Lazor (DIRECTOR) |
| Authorized Official Contact | 4105699533 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurel Pediatric And Teen Medical Center 2014 S Tollgate Rd Suite 200 Bel Air MD 21015-5903 Ph: (410) 569-9533 | Laurel Pediatric And Teen Medical Center 2014 S Tollgate Rd Suite 200 Bel Air MD 21015-5903 Ph: (410) 569-9533 |
| NPI Number | 1093724163 |
|---|---|
| Provider Enumeration Date | 08/06/2006 |
| Last Update Date | 12/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093724163 | NPI | - | NPPES |
| 293901100 | Medicaid | MD | |
| 408959600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D34413 (Maryland) | Primary |
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