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General NPI Number Information
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NPI Number | 1013120153
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Entity Type | Organization
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Legal Business Name | SPAA
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8600 OLD GEORGETOWN RD SUBURBAN HOSPITAL
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone | 301-896-3100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 79050 SUBURBAN PHYSICIAN ASSISTANT ASSOCIATES
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City | BALTIMORE
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State | MD
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Zip | 21279-0050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN GRAGNOLATI
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Credential |
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Telephone | 301-896-2574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | C0000937
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License Number State | MD
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