Healthcare Provider Details

I. General information

NPI: 1306062880
Provider Name (Legal Business Name): FORT WASHINGTON PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 LIVINGSTON RD
FORT WASHINGTON MD
20744-5151
US

IV. Provider business mailing address

PO BOX 64312
BALTIMORE MD
21264-4312
US

V. Phone/Fax

Practice location:
  • Phone: 301-203-2000
  • Fax:
Mailing address:
  • Phone: 301-983-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LALEH MOSAVATI
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-983-6656