Healthcare Provider Details

I. General information

NPI: 1699906594
Provider Name (Legal Business Name): ODE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW SUITE 200
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

14725 JAYSTONE DR
SILVER SPRING MD
20905-7410
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-1148
  • Fax: 202-291-1205
Mailing address:
  • Phone: 301-989-0651
  • Fax: 301-384-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD16434
License Number StateDC

VIII. Authorized Official

Name: DIANE M COTTON
Title or Position: ADMIMISTRATIVE DIRECTOR
Credential:
Phone: 301-873-2529