Provider Demographics
NPI:1730229956
Name:MAZIQUE PEDIATRICS, P.C.
Entity type:Organization
Organization Name:MAZIQUE PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKILLNARINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-333-8900
Mailing Address - Street 1:10416 CAMPUS WAY S
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1390
Mailing Address - Country:US
Mailing Address - Phone:301-333-8900
Mailing Address - Fax:301-333-8826
Practice Address - Street 1:10416 CAMPUS WAY S
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1390
Practice Address - Country:US
Practice Address - Phone:301-333-8900
Practice Address - Fax:301-333-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38503261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD064981300Medicaid
MD064981300Medicaid