| Organization Name: | CLARKSBURG PEDIATRICS LLC |
| NPI Number: | 1073929386 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAUREN ELIZABETH HALEY (PEDIATRIC PRIMARY CARE NP) |
| Mailing Address: | 23218 Brewers Tavern Way Clarksburg |
| State: | MD US |
| Postal Code: | 208714391 |
| Phone Number: | 3015288181 |
| Fax Number: | |
| NPI Enumeration Date: | 07/08/2014 |
| NPI Last Update Date: | 07/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | R186838 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |