Healthcare Provider Details

I. General information

NPI: 1356852628
Provider Name (Legal Business Name): INDUSTRIAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7794 MARLBORO PIKE
FORESTVILLE MD
20747-4410
US

IV. Provider business mailing address

PO BOX 316
OAKTON VA
22124-0316
US

V. Phone/Fax

Practice location:
  • Phone: 800-521-8065
  • Fax: 703-842-8416
Mailing address:
  • Phone: 800-521-8065
  • Fax: 703-842-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number22964
License Number StateMD

VIII. Authorized Official

Name: BRANDI LANN
Title or Position: OFFICE MANAGER
Credential:
Phone: 800-521-8065