MEDICARE: SILVER SPRING MEDICAL CENTER, 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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1386920056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER SPRING MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 AMHERST AVE
Second Line	:	SUITE 102
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4665
Country	:	US
Telephone Number	:	301-933-7827
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JOHN MELMED
Credential	:	MD
Telephone Number	:	301-933-7827

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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