Healthcare Provider Details

I. General information

NPI: 1649538331
Provider Name (Legal Business Name): MARYLAND EYE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 UNIVERSITY BLVD E SUITE 11
SILVER SPRING MD
20903-2916
US

IV. Provider business mailing address

831 UNIVERSITY BLVD E SUITE 11
SILVER SPRING MD
20903-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-0431
  • Fax: 301-431-0470
Mailing address:
  • Phone: 301-431-0431
  • Fax: 301-431-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMAN F GHAHREMANI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 301-431-0431