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General NPI Number Information
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NPI Number | 1710797303
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Entity Type | Organization
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Legal Business Name | PARK PEDIATRICS
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 7500 HANOVER PKWY STE 204
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City | GREENBELT
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State | MD
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Zip | 20770-2009
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Country | US
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Telephone | 301-232-3638
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Fax | 301-891-6841
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Provider Business Mailing Address
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Address Line | 7610 CARROLL AVE STE 400
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6321
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Country | US
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Telephone | 301-891-6141
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Fax | 301-891-6841
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LAVANYA SITHANANDAM
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Credential | MD
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Telephone | 301-891-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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