HERITAGE PEDIATRICS, INC. (NPI# 1972903201) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972903201 |
| Entity Type | Organization |
| Organization Name | HERITAGE PEDIATRICS, INC. |
| Practice Address |
1450 Mercantile Ln Suite #217 Largo MD 20774-5376 |
| Mailing Address |
Po Box 7598 Largo MD 20792-7598 |
| Practice Telephone | 3013415000 |
| Practice Fax Number | 3013415001 |
| Mailing Telephone | 3013415000 |
| Mailing Fax Number | 3013415001 |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2014-08-22 |
| Authorized Official Name | DR. BABAJIDE EYITAYO FADITAN (PRESIDENT) |
| Authorized Official Telephone | 3013415000 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | D74464 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 378100300 | 05 | |
| MD | INDIVIDUAL NPI | 1699087403 | 01 |
| Street Address |
1450 MERCANTILE LN SUITE #217 |
| City | LARGO |
| State | MD |
| Zip Code | 20774-5376 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720070261 | David A Gooray | Internal Medicine | 1450 Mercantile Ln, Suite 217, Largo, MD 20774-5376 | 2005-08-19 |
| 1497287361 | Holistic Health & Wellness Medical Spa | Physical Therapist | 1450 Mercantile Ln, 221, Largo, MD 20774-5376 | 2017-03-30 |
| 1831640465 | Anne Arundel Physician Group LLC | Dietitian, Registered | 1450 Mercantile Ln, Suite 111, Largo, MD 20774-5376 | 2016-10-19 |
| 1427505825 | Holistic Health and Wellness Medical Spa | Nurse Practitioner | 1450 Mercantile Ln, Suite 221, Largo, MD 20774-5376 | 2016-09-02 |
| 1316372931 | Anne Arundel Physician Group, LLC | Internal Medicine | 1450 Mercantile Ln, Suite 111, Largo, MD 20774-5376 | 2013-09-13 |
| 1679821458 | Meetu Agrawal | Internal Medicine | 1450 Mercantile Ln, Suite 111, Largo, MD 20774-5376 | 2012-08-27 |
| 1316232135 | Jatin R Matta | Physician Assistant | 1450 Mercantile Ln, Suite 217, Largo, MD 20774-5376 | 2011-06-09 |
| 1750696779 | Susan E Jenkins, M.d.p.a. | Obstetrics & Gynecology | 1450 Mercantile Ln, Suite 117, Largo, MD 20774-5376 | 2010-08-13 |
| 1922249200 | Lisa V. Thompson, Dds, LLC | Clinic/Center | 1450 Mercantile Ln, Suite 207a, Largo, MD 20774-5376 | 2009-03-16 |
| 1992998975 | East Coast Gastroenterology LLC | Pathology | 1450 Mercantile Ln, Suite 217, Largo, MD 20774-5376 | 2007-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922637156 | Marie Charlotte Teboutsou Tsodzou | Nurse Practitioner | 9317 Lavall Drive, Upper Marlboro, MD 20774 | 2020-04-08 |
| 1467093443 | Richland Support Services Corp. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11551 Joyceton Drive, Upper Marlboro, MD 20774 | 2019-10-01 |
| 1770134124 | Alan L Kahn | Counselor | 301 Largo Rd., Largo, MD 20774 | 2019-09-26 |
| 1619522034 | Francisca Ifeoma Alintah | Registered Nurse | 511 Dennis Magruder Dr., Upper Marlboro, MD 20774 | 2019-08-02 |
| 1609337146 | Crystal Osuchukwu | Counselor | 1300 Mccormick Dr, Upper Marlboro, MD 20774 | 2019-03-27 |
| 1861968489 | Collaborative Concepts of Maryland | Counselor | 1400 Mercantile Lane, Suite 208, Largo, MD 20774 | 2018-10-22 |
| 1073097622 | Triple Angels Homecare Services, Inc. | In Home Supportive Care | 1210 Dixie Bowie Way, Upper Marlboro, MD 20774 | 2018-09-19 |
| 1922589654 | Optimum Resource Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 711 Harry S. Truman Dr, Unit #105, Largo, MD 20774 | 2018-08-21 |
| 1811475254 | Kolawole Richard Olatunde | Home Health Aide | 11405 Villa Court, Upper Marlboro, MD 20774 | 2018-07-28 |
| 1548747769 | Tiara Williams | Counselor | 15207 Harriet Clotilda Way, Upper Marlboro, MD 20774 | 2018-07-20 |
| Find all providers in zip 20774 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548526601 | Olivia Lauren Potter | Pediatrics | 500 Belcher Rd S Apt 112, Largo, FL 33771-2768 | 2012-04-03 |
| 1609102771 | Rana Tabassum | Pediatrics | 8243 Wild Oaks Cir, Largo, FL 33773-2845 | 2009-10-26 |
| 1023114097 | Steven Michael Moore | Pediatrics | 13131 66th St, Largo, FL 33773-1812 | 2006-09-16 |
| 1881619716 | Shayne M Gadea | Pediatrics | 12951 Walsingham Rd, Largo, FL 33774-3538 | 2006-07-13 |
| 1073563680 | Carlos Jesus Cano | Pediatrics | 1395 W Bay Dr, Largo, FL 33770 | 2006-05-12 |
| 1679523732 | Fran E Sterling | Pediatrics | 1395 West Bay Drive, Largo, FL 33770 | 2006-05-11 |
| 1881678043 | Annette Dawn Bartley-satuyi | Pediatrics | 1300 Caraway Ct Ste 106, Largo, MD 20774-5462 | 2005-12-01 |
| 1568450617 | Maria V Lopez | Pediatrics | 12170 Seminole Blvd, Largo, FL 33778-2833 | 2005-10-12 |
| 1538166608 | Timothy Joseph Vaughan | Pediatrics | 1725 E Bay Dr, Suite A, Largo, FL 33771-2208 | 2005-07-05 |
| 1639538713 | Peninsula Pediatrics of West Florida, Pllc | Pediatrics | 13131 66th St N, Largo, FL 33773-1812 | 2016-02-17 |
| Find all providers in LARGO | ||||
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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.