Healthcare Provider Details

I. General information

NPI: 1245642578
Provider Name (Legal Business Name): THE PRIMARY CARE COALITION OF MONTGOMERY COUNTY, MARYLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 GEORGIA AVE FL 10
SILVER SPRING MD
20910-3737
US

IV. Provider business mailing address

8757 GEORGIA AVE FL 10
SILVER SPRING MD
20910-3737
US

V. Phone/Fax

Practice location:
  • Phone: 301-628-3469
  • Fax: 301-608-8099
Mailing address:
  • Phone: 301-628-3469
  • Fax: 301-608-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE GALEN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-628-3649