Healthcare Provider Details

I. General information

NPI: 1285853135
Provider Name (Legal Business Name): PARK PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 CARROLL AVE STE 400
TAKOMA PARK MD
20912-6321
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: 301-891-6841
Mailing address:
  • Phone: 301-891-6141
  • Fax: 301-891-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier400651800
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: DR. SITHANANDAM SADHASIVAM
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 301-891-6141