Healthcare Provider Details

I. General information

NPI: 1063749547
Provider Name (Legal Business Name): FLYNN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 NEW CHURCH RD
DAMASCUS MD
20872-2000
US

IV. Provider business mailing address

3470 OLNEY LAYTONSVILLE RD
OLNEY MD
20832-1734
US

V. Phone/Fax

Practice location:
  • Phone: 240-355-1040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. GAWIN FLYNN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 240-355-1040