Healthcare Provider Details

I. General information

NPI: 1871307652
Provider Name (Legal Business Name): CHILDRENS PEDIATRICIANS & ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 QUINCE ORCHARD RD SUITE 350
GAITHERSBURG MD
20878-5053
US

IV. Provider business mailing address

PO BOX 744787
ATLANTA GA
30374-4787
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-3633
  • Fax: 301-948-9884
Mailing address:
  • Phone: 301-754-3060
  • Fax: 301-681-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK JANOWIAK
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 301-572-1382