Healthcare Provider Details

I. General information

NPI: 1518312990
Provider Name (Legal Business Name): MEDSTAR HEALTH AT BRANDYWINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 BRANDYWINE RD SUITE 150
BRANDYWINE MD
20613-5815
US

IV. Provider business mailing address

13950 BRANDYWINE RD SUITE 150
BRANDYWINE MD
20613-5815
US

V. Phone/Fax

Practice location:
  • Phone: 301-782-2220
  • Fax: 301-782-2221
Mailing address:
  • Phone: 301-782-2220
  • Fax: 301-782-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY L SYLVESTER
Title or Position: DIRECTOR OF FINANCE AND BILLING
Credential:
Phone: 301-877-4564