Healthcare Provider Details

I. General information

NPI: 1215892757
Provider Name (Legal Business Name): RIVERSIDE DIABETES CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 KENILWORTH AVE STE 1200
RIVERDALE MD
20737-1339
US

IV. Provider business mailing address

6510 KENILWORTH AVE STE 1200
RIVERDALE MD
20737-1339
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-7750
  • Fax: 240-582-7411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: INGEBORG JACKS-CURTIS
Title or Position: MANAGER
Credential:
Phone: 301-873-3313