Healthcare Provider Details

I. General information

NPI: 1245901347
Provider Name (Legal Business Name): AMARILYS VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE AVE
SILVER SPRING MD
20993-0002
US

IV. Provider business mailing address

6469 SWIMMER ROW WAY
COLUMBIA MD
21044-4962
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-3088
  • Fax:
Mailing address:
  • Phone: 410-905-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0036237
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: