Healthcare Provider Details

I. General information

NPI: 1598942526
Provider Name (Legal Business Name): SUBURBAN HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1422
US

IV. Provider business mailing address

PO BOX 79049
BALTIMORE MD
21279-0049
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-6508
  • Fax: 301-896-6505
Mailing address:
  • Phone: 412-826-1065
  • Fax: 412-826-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SANDRA SEWELL
Title or Position: PROGRAM MANAGER
Credential:
Phone: 301-896-6508