Healthcare Provider Details

I. General information

NPI: 1639334865
Provider Name (Legal Business Name): BETHESDA ALLERGY & ASTHMA CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 OLD GEORGETOWN RD SUITE #407
BETHESDA MD
20814-1911
US

IV. Provider business mailing address

10401 OLD GEORGETOWN RD SUITE #407
BETHESDA MD
20814-1911
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-4090
  • Fax:
Mailing address:
  • Phone: 301-564-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN S. IRONS
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 301-564-4090