Provider Demographics
NPI:1134102767
Name:SARMIENTO, PEDRO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:SARMIENTO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11885 HOLLY LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3181
Mailing Address - Country:US
Mailing Address - Phone:301-932-5299
Mailing Address - Fax:301-645-9442
Practice Address - Street 1:11885 HOLLY LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-932-5299
Practice Address - Fax:301-645-9442
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0039620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1982753877OtherGROUP NPI FOR PEDIATRIC AFTER HOURS
VA188876-192159OtherBCBS VA PIN FOR PEDIATRIC AFTER HOURS
MDKH18PE-52297105OtherBCBS MD PIN FOR PEDIATRIC AFTER HOURS
DC5228-0007OtherBCBS NCA PIN FOR PEDIATRIC AFTER HOURS