Healthcare Provider Details

I. General information

NPI: 1093637720
Provider Name (Legal Business Name): PARK PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR STE D
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

7610 CARROLL AVE STE 400
TAKOMA PARK MD
20912-6321
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-6141
  • Fax:
Mailing address:
  • Phone: 301-891-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAVANYA SITHANANDAM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 301-891-6141