Healthcare Provider Details

I. General information

NPI: 1124192513
Provider Name (Legal Business Name): GEORGE F SENGSTACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 FERRARA DR
SILVER SPRING MD
20906-4709
US

IV. Provider business mailing address

3929 FERRARA DR
SILVER SPRING MD
20906-4709
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-3100
  • Fax: 301-942-5298
Mailing address:
  • Phone: 301-942-3100
  • Fax: 301-942-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD12121
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: