Healthcare Provider Details

I. General information

NPI: 1083842124
Provider Name (Legal Business Name): MARYLAND UROGYNECOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2009
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MEDICAL CENTER DR STE 220
ROCKVILLE MD
20850-6338
US

IV. Provider business mailing address

9707 MEDICAL CENTER DR STE 220
ROCKVILLE MD
20850-6338
US

V. Phone/Fax

Practice location:
  • Phone: 240-645-4683
  • Fax: 240-654-4696
Mailing address:
  • Phone: 240-645-4683
  • Fax: 240-654-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: THAO NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 240-654-4683