Healthcare Provider Details

I. General information

NPI: 1245952985
Provider Name (Legal Business Name): SRIG MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21030 FREDERICK RD STE 102G
GERMANTOWN MD
20876-4133
US

IV. Provider business mailing address

11829 PEPPERVINE DR # 20871
CLARKSBURG MD
20871-6312
US

V. Phone/Fax

Practice location:
  • Phone: 240-393-6880
  • Fax:
Mailing address:
  • Phone: 240-393-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ATCHUTHA GEETHA CHAN CHILAKAMARRI
Title or Position: MD
Credential:
Phone: 240-439-8812