MEDICARE: CENTER FOR RETINAL DISEASES AND SURGERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D0044710	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4332262	OTHER		AETNA
2	330652	OTHER		MDIPA, OPT CHOICE, MAMSI
3	LW08	OTHER	MD	CAREFIRST
4	7457	OTHER	DC	CAREFIRST

General Provider Information

NPI Number	:	1003850850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR RETINAL DISEASES AND SURGERY, LLC

Provider Business Mailing Address
First Line	:	6420 ROCKLEDGE DR
Second Line	:	SUITE 4900
City	:	BETHESDA
State	:	MD
Zip	:	20817-7837
Country	:	US
Telephone Number	:	301-571-2000
Fax Number	:	301-571-4307

Provider Business Practice Location Address
First Line	:	6420 ROCKLEDGE DR
Second Line	:	SUITE 4900
City	:	BETHESDA
State	:	MD
Zip	:	20817-7837
Country	:	US
Telephone Number	:	301-571-2000
Fax Number	:	301-571-4307

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. STEPHEN S PAPPAS JR.
Credential	:	M.D.
Telephone Number	:	301-571-2000

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/22/2020

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Directions to “CENTER FOR RETINAL DISEASES AND SURGERY, LLC ” Practice Location

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