MEDICARE: REVERED MEDICAL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QI0500X	Infusion Therapy Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center
3	261QP2300X	Primary Care Clinic/Center
4	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1811547540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVERED MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2151
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20847-2151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6246 MONTROSE RD
Second Line	:
City	:	NORTH BETHESDA
State	:	MD
Zip	:	20852-4119
Country	:	US
Telephone Number	:	240-856-1393
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OWNER
Name	:	MRS. JOSEPHINE MOORE
Credential	:	NP
Telephone Number	:	240-856-1391

Provider Enumeration Date	:	09/15/2019
Last Update Date	:	07/26/2021

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