Provider Demographics
NPI:1144964156
Name:XPRESS PEDIATRICS, LLC
Entity type:Organization
Organization Name:XPRESS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDER
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GATTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-616-1616
Mailing Address - Street 1:1419 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3808
Mailing Address - Country:US
Mailing Address - Phone:240-376-1616
Mailing Address - Fax:855-825-6158
Practice Address - Street 1:1419 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3808
Practice Address - Country:US
Practice Address - Phone:240-376-1616
Practice Address - Fax:855-825-6158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XPRESS PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-25
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty