Healthcare Provider Details

I. General information

NPI: 1922395581
Provider Name (Legal Business Name): MMG - GEORGETOWN FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW SUITE 115
WASHINGTON DC
20016-4300
US

IV. Provider business mailing address

PO BOX 418681
BOSTON MA
02241-8681
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-0015
  • Fax: 202-237-0076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE SCHNEIDER
Title or Position: VICE PRESIDENT
Credential:
Phone: 703-558-1403