Healthcare Provider Details

I. General information

NPI: 1841303914
Provider Name (Legal Business Name): LYLES AND SKURDAL, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MITCHELLVILLE RD SUITE B322
BOWIE MD
20716-3104
US

IV. Provider business mailing address

4000 MITCHELLVILLE RD SUITE B322
BOWIE MD
20716-3104
US

V. Phone/Fax

Practice location:
  • Phone: 301-860-0305
  • Fax: 301-860-0307
Mailing address:
  • Phone: 301-860-0305
  • Fax: 301-860-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0029051
License Number StateMD

VIII. Authorized Official

Name: DR. ROBERT L LYLES JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-860-0305