Healthcare Provider Details

I. General information

NPI: 1154657039
Provider Name (Legal Business Name): INTERNAL MEDICINE ASOCIATES OF MONTGOMERY VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18550 OFFICE PARK DR
MONTGOMERY VILLAGE MD
20886-0586
US

IV. Provider business mailing address

18550 OFFICE PARK DR
MONTGOMERY VILLAGE MD
20886-0586
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-2700
  • Fax: 301-990-7170
Mailing address:
  • Phone: 301-330-2700
  • Fax: 301-990-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. BALNATH BHANDARY
Title or Position: PRESIDENT
Credential: MD
Phone: 301-330-2700