Provider Demographics
NPI:1427887173
Name:RIVERDALE PARK PEDIATRICS PC
Entity type:Organization
Organization Name:RIVERDALE PARK PEDIATRICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGUILAR LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-316-7066
Mailing Address - Street 1:202 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5802
Mailing Address - Country:US
Mailing Address - Phone:410-768-8525
Mailing Address - Fax:
Practice Address - Street 1:202 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5802
Practice Address - Country:US
Practice Address - Phone:410-768-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERDALE PARK PEDIATRICS PC AT GLEN BURNIE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-31
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty