Healthcare Provider Details

I. General information

NPI: 1013497700
Provider Name (Legal Business Name): ADVENTIST PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 CARROLL AVE STE 410
TAKOMA PARK MD
20912-6321
US

IV. Provider business mailing address

820 W DIAMOND AVE
GAITHERSBURG MD
20878-1419
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-5079
  • Fax:
Mailing address:
  • Phone: 301-315-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN PULIO
Title or Position: SVP/CFO
Credential:
Phone: 301-315-3826