Healthcare Provider Details

I. General information

NPI: 1225942410
Provider Name (Legal Business Name): PARK PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13976 BALTIMORE AVE
LAUREL MD
20707-5086
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 StateNULL

VIII. Authorized Official

Name: CECILIA BYRNES
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-891-6141