Healthcare Provider Details

I. General information

NPI: 1326450156
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

2331 BROADBIRCH DR
SILVER SPRING MD
20904-1934
US

V. Phone/Fax

Practice location:
  • Phone: 301-902-1073
  • Fax: 301-902-1086
Mailing address:
  • Phone: 301-902-1073
  • Fax: 301-902-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN H BRICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-902-1073