Healthcare Provider Details

I. General information

NPI: 1225490196
Provider Name (Legal Business Name): OLNEY ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 OLANDWOOD CT SUITE 103
OLNEY MD
20832
US

IV. Provider business mailing address

3407 OLANDWOOD CT SUITE 103
OLNEY MD
20832
US

V. Phone/Fax

Practice location:
  • Phone: 301-570-8671
  • Fax: 410-290-6676
Mailing address:
  • Phone: 301-570-8671
  • Fax: 410-290-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUDRA RAI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-290-6677