Healthcare Provider Details

I. General information

NPI: 1396932687
Provider Name (Legal Business Name): CHILDREN'S PEDIATRICIANS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date: 02/03/2025
Reactivation Date: 02/12/2025

III. Provider practice location address

12211 PLUM ORCHARD DR STE 220
SILVER SPRING MD
20904-7903
US

IV. Provider business mailing address

12211 PLUM ORCHARD DR
SILVER SPRING MD
20904-7903
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-3040
  • Fax: 301-681-0789
Mailing address:
  • Phone: 301-754-3040
  • 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: MHA
Phone: 301-572-1382