Healthcare Provider Details

I. General information

NPI: 1760833917
Provider Name (Legal Business Name): SILVER SPRING PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 BROADBIRCH DR STE 130
SILVER SPRING MD
20904-1966
US

IV. Provider business mailing address

2301 BROADBIRCH DR STE 130
SILVER SPRING MD
20904-1966
US

V. Phone/Fax

Practice location:
  • Phone: 301-625-2800
  • Fax: 301-625-9046
Mailing address:
  • Phone: 301-625-2800
  • Fax: 301-625-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0064348
License Number StateMD

VIII. Authorized Official

Name: JUDY WANG
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 301-625-2800