Healthcare Provider Details

I. General information

NPI: 1396740379
Provider Name (Legal Business Name): MARYLAND DIGESTIVE DISEASE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 210
LAUREL MD
20707-5268
US

IV. Provider business mailing address

7350 VAN DUSEN RD STE 250
LAUREL MD
20707-5268
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-5500
  • Fax: 301-498-7346
Mailing address:
  • Phone: 301-498-5500
  • Fax: 301-498-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. GEORGIA L GALIE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 301-498-5500