Healthcare Provider Details

I. General information

NPI: 1942448113
Provider Name (Legal Business Name): SOUTHERN MARYLAND MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ALLENTOWN RD STE 400
CAMP SPRINGS MD
20746-4585
US

IV. Provider business mailing address

7500 GREENWAY CENTER DR STE 1200
GREENBELT MD
20770-3556
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-0150
  • Fax: 301-868-0243
Mailing address:
  • Phone: 301-486-7580
  • Fax: 301-486-7581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GIRISH SADASHIVA RAO
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 301-552-1200