Provider Demographics
NPI:1447371885
Name:NORTH PARK PEDIATRICS, LLC
Entity type:Organization
Organization Name:NORTH PARK PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WINIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-838-0343
Mailing Address - Street 1:4C NORTH AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2330
Mailing Address - Country:US
Mailing Address - Phone:410-838-9142
Mailing Address - Fax:
Practice Address - Street 1:4C NORTH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2330
Practice Address - Country:US
Practice Address - Phone:410-838-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00533922080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF59962Medicare UPIN
MDE31681Medicare UPIN
MDH51548Medicare UPIN