Healthcare Provider Details

I. General information

NPI: 1730452905
Provider Name (Legal Business Name): JOHN S ENG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11404 OLD GEORGETOWN RD SUITE 206
ROCKVILLE MD
20852-2865
US

IV. Provider business mailing address

11404 OLD GEORGETOWN RD SUITE 206
ROCKVILLE MD
20852-2865
US

V. Phone/Fax

Practice location:
  • Phone: 301-468-5991
  • Fax: 301-468-5979
Mailing address:
  • Phone: 301-468-5991
  • Fax: 301-468-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0016625
License Number StateMD

VIII. Authorized Official

Name: DR. JOHN S ENG
Title or Position: OWNER
Credential:
Phone: 301-468-5991