Type 1 Individual Provider
Type 1 Individual Provider is an Exclusive Provider Organization in Silver Spring, Maryland. Licensed in Maryland. Registered with an NPI since 2009.
- Licensed in
- MD
- In the registry since
- 2009
Practice location Address checks out
1620 Elton RdSilver Spring, MD 20903-1740
Phone: (301) 439-7191
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Exclusive Provider Organization (primary) | Taxonomy 302F00000X · Licence LC2381 (MD) |
|---|
Record details
| NPI number | 1952543191 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Brena Gibson — Human Resources Director · (301) 439-7191 |
| Other names | Type 1 Individual Provider |
| NPI enumerated | April 2, 2009 |
| Last updated in NPPES | April 8, 2009 |
| Mailing address | 1620 Elton Rd, Silver Spring, MD 20903-1740 |
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