Provider Demographics
NPI:1760833917
Name:SILVER SPRING PEDIATRICS, LLC
Entity Type:Organization
Organization Name:SILVER SPRING PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-625-2800
Mailing Address - Street 1:12301 OLD COLUMBIA PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1656
Mailing Address - Country:US
Mailing Address - Phone:301-625-2800
Mailing Address - Fax:301-625-9046
Practice Address - Street 1:12301 OLD COLUMBIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1656
Practice Address - Country:US
Practice Address - Phone:301-625-2800
Practice Address - Fax:301-625-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty