Healthcare Provider Details

I. General information

NPI: 1295520732
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 DENNIS AVE FL 2
SILVER SPRING MD
20902-4136
US

IV. Provider business mailing address

1401 ROCKVILLE PIKE
ROCKVILLE MD
20852-1428
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-1875
  • Fax:
Mailing address:
  • Phone: 240-777-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMEELAH JOHNSON
Title or Position: MANAGER
Credential:
Phone: 571-320-0150