Healthcare Provider Details

I. General information

NPI: 1609971175
Provider Name (Legal Business Name): SUBURBAN SPECIALTY CARE PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/08/2008
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: 301-896-7596
  • Fax: 301-530-7989
Mailing address:
  • Phone: 412-826-1065
  • Fax: 412-826-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW G POFFENROTH
Title or Position: PRESIDENT
Credential:
Phone: 301-581-2200