Provider Demographics
NPI:1548096084
Name:THRIVE AND GROW PEDIATRIC ENDOCRINOLOGY, LLC
Entity type:Organization
Organization Name:THRIVE AND GROW PEDIATRIC ENDOCRINOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-553-5003
Mailing Address - Street 1:6000 EXECUTIVE BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:N BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3803
Mailing Address - Country:US
Mailing Address - Phone:240-553-5003
Mailing Address - Fax:240-553-5005
Practice Address - Street 1:6000 EXECUTIVE BLVD STE 312
Practice Address - Street 2:
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:240-553-5003
Practice Address - Fax:240-553-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty