Healthcare Provider Details

I. General information

NPI: 1720429194
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S FREDERICK AVE
GAITHERSBURG MD
20877-2307
US

IV. Provider business mailing address

401 HUNGERFORD DR FL 6
ROCKVILLE MD
20850-4154
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-1571
  • Fax: 301-284-4701
Mailing address:
  • Phone: 240-777-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DIANA AZUCENA CORTEZ
Title or Position: MANAGEMENT
Credential:
Phone: 240-672-6758