Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Park Avenue Pediatrics PA

Organization Pediatrics Physician · NPI 1417914797

Park Avenue Pediatrics PA is a Pediatrics Physician in Roanoke Rapids, North Carolina. Licensed in North Carolina. Registered with an NPI since 2006.

Licensed in
NC
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

529 Becker Dr
Roanoke Rapids, NC 27870-3303
Phone: (252) 537-6465
Fax: (252) 535-0951
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 38443 (NC)

Record details

NPI number1417914797
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Sandeep Tiwari — President · (252) 537-6465
NPI enumeratedApril 28, 2006
Last updated in NPPESFebruary 15, 2022
Certification dateFebruary 15, 2022
Mailing address529 Becker Dr, Roanoke Rapids, NC 27870-3303

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