Healthcare Provider Details

I. General information

NPI: 1821621707
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 11/27/2023
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 CRYSTAL ROCK DR
GERMANTOWN MD
20874-1593
US

IV. Provider business mailing address

19401 CRYSTAL ROCK DR
GERMANTOWN MD
20874-1593
US

V. Phone/Fax

Practice location:
  • Phone: 301-353-8010
  • Fax:
Mailing address:
  • Phone: 301-353-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SOMMER MARTINE BARNES
Title or Position: EHR PRACTICE MANAGER
Credential:
Phone: 240-777-1643