Healthcare Provider Details

I. General information

NPI: 1861551061
Provider Name (Legal Business Name): ROCKVILLE INTERNAL MEDICINE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SEVEN LOCKS RD SUITE 111
ROCKVILLE MD
20854-2957
US

IV. Provider business mailing address

PO BOX 79632
BALTIMORE MD
21279-0632
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-5020
  • Fax: 301-294-7569
Mailing address:
  • Phone: 301-762-5020
  • Fax: 301-309-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOYCE HELLER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 301-762-5020