MED-PED HEALTHCARE, LLC (NPI# 1114314150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114314150 |
| Entity Type | Organization |
| Organization Name | MED-PED HEALTHCARE, LLC |
| Practice Address |
4701 Melbourne Pl College Park MD 20740-2540 |
| Mailing Address |
4701 Melbourne Place College Park MD 20740 |
| Practice Telephone | 3013454400 |
| Practice Fax Number | 3013456200 |
| Mailing Telephone | 3013454400 |
| Mailing Fax Number | 3013456200 |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2015-04-16 |
| Authorized Official Name | MR. JAMAL FADUL (OWNER) |
| Authorized Official Telephone | 3013454400 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | D0053745 | MD | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | MEDICARE PTAN | G00445 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972962553 | Med-ped Healthcare, LLC | General Practice | 7582 Annapolis Rd, Hyattsville, MD 20784-1744 | 2016-02-11 |
| Street Address |
4701 MELBOURNE PL |
| City | COLLEGE PARK |
| State | MD |
| Zip Code | 20740-2540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548871783 | Ebdl LLC | Clinical Medical Laboratory | 4701 Melbourne Pl, College Park, MD 20740-2540 | 2020-08-12 |
| 1487201224 | Campus Care Physical Therapy LLC | Physical Therapist | 4701 Melbourne Pl, College Park, MD 20740-2540 | 2019-08-26 |
| 1902258130 | Premium Pharmacy Services Inc | Pharmacy | 4701 Melbourne Pl, College Park, MD 20740-2540 | 2016-07-12 |
| 1447605712 | Express Healthcare, LLC | Clinic/Center | 4701 Melbourne Pl, College Park, MD 20740-2540 | 2016-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073147633 | S.a.f.e. Counseling Services LLC | Counselor | 6210 Greenbelt Road, L 4, Berwyn Heights, MD 20740 | 2020-02-23 |
| 1326528621 | Ryan Rehabilitation LLC | Counselor | 7100 Baltimore Ave Ste 105, College Park, MD 20740 | 2018-08-16 |
| 1760981120 | L. Jones-dove & Associates Tooth Spa LLC | Dentist | 6103 Greenbelt Road, College Park, MD 20740 | 2018-02-12 |
| 1538682257 | Heather Gambacorto | Behavior Technician | 3525 Marlbrough Way, College Park, MD 20740 | 2017-07-25 |
| 1841722691 | Bradley Weitzel | Specialist/Technologist | 4068 Field House Drive, College Park, MD 20740 | 2017-03-31 |
| 1083152284 | Kabrima Y Petty | Nurse Practitioner | 10201 Baltimore Ave Apt 5102, College Park, MD 20740 | 2017-02-08 |
| 1659728517 | Brownstone Project In Md | Community/Behavioral Health | 6201 Greenbelt Rd Ste M6, Berwyn Heights, MD 20740 | 2016-05-20 |
| 1114371093 | Thomas Lowell Bennett | Specialist/Technologist | 7675 Baltimore Ave, R 0100, College Park, MD 20740 | 2016-04-18 |
| 1306226808 | Linda Ronma Williams | Nurse Practitioner | 4701 Melbourne Place, College Park, MD 20740 | 2015-06-01 |
| 1124427927 | Sarah Elizabeth Woerner | Pharmacist | 7300 Baltimore Boulevard, College Park, MD 20740 | 2014-08-18 |
| Find all providers in zip 20740 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104273952 | Setif Inc | Preferred Provider Organization | 4920 Niagara Rd Ste 107, College Park, MD 20740-1121 | 2016-05-23 |
| 1326491242 | Andrew J Newsome Dds, PC | Preferred Provider Organization | 2230 Godby Rd, College Park, GA 30349-5002 | 2016-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184175440 | Black Nurses Rock - Baltimore. Md Chapter | Preferred Provider Organization | 7017 Hamlet Avenue, Parkville, MD 21234 | 2016-10-20 |
| 1073063632 | Tamieko Ross-anyaso | Preferred Provider Organization | 5919 Lebanon Ln, Elkridge, MD 21075-5142 | 2016-10-07 |
| 1124574744 | I Can't We Can Counseling Center | Preferred Provider Organization | 7060 O(akland Mills Rd, Columbia, MD 21043 | 2016-09-01 |
| 1518343599 | B& E Ventures Plc | Preferred Provider Organization | 17408 Cherokee Ln, Olney, MD 20832-2163 | 2015-07-31 |
| 1306235601 | Hyun Jang | Preferred Provider Organization | 6650 Belair Rd, Baltimore, MD 21206-1874 | 2015-01-10 |
| 1295134005 | Prince Georges County Health Dept. | Preferred Provider Organization | 301 Hampton Park Blvd, Capitol Hgts, MD 20743-3822 | 2014-08-18 |
| 1669881272 | Parker Psychiatric Services, Incorporated | Preferred Provider Organization | 940 Madison Ave Ste 202, Baltimore, MD 21201-2113 | 2014-08-07 |
| 1962788323 | Maryland Rehab and Pain Specialists,llc | Preferred Provider Organization | 5070 Dorsey Hall Dr, Suite 101, Ellicott City, MD 21042-7711 | 2011-10-31 |
| 1598046567 | Carefirst | Preferred Provider Organization | 1505 May Dr, Salisbury, MD 21804-7258 | 2011-09-06 |
| 1972809911 | Good Health Nutrition Services Inc | Preferred Provider Organization | 7515 Annapolis Rd Ste 402, Hyattsville, MD 20784-1752 | 2011-02-09 |
| Find all providers with the same taxonomy | ||||
| City | COLLEGE PARK |
| Zip Code | 20740 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.