Organization
PARK AVENUE PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDEEP KUMAR TIWARI MD (PRESIDENT)
(252) 537-6465
Entity
Organization
Contact information
Practice address
529 BECKER DR, ROANOKE RAPIDS, NC 27870-3303
(252) 537-6465
(252) 535-0951
Mailing address
529 BECKER DR, ROANOKE RAPIDS, NC 27870-3303
(252) 537-6465
(252) 535-0951
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38443
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006701019
—
VA
01
—
139315
BC VA
VA
01
—
15527
BC NC
NC
05
—
8915527
—
NC
Enumeration date
04/28/2006
Last updated
02/15/2022
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