Healthcare Provider Details

I. General information

NPI: 1639576895
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E GUDE DR
ROCKVILLE MD
20850-5307
US

IV. Provider business mailing address

401 HUNGERFORD DR FL 6
ROCKVILLE MD
20850-4154
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-1680
  • Fax:
Mailing address:
  • Phone: 240-672-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA AZUCENA CORTEZ
Title or Position: MANAGEMENT
Credential:
Phone: 240-672-6758