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General NPI Number Information
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NPI Number | 1215747563
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Entity Type | Organization
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Legal Business Name | SOUTHERN MARYLAND MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 6510 KENILWORTH AVE STE 1400
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City | RIVERDALE
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State | MD
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Zip | 20737-1339
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Country | US
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Telephone | 301-618-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 GREENWAY CENTER DR STE 1200
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City | GREENBELT
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State | MD
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Zip | 20770-3556
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Country | US
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Telephone | 301-486-7580
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Fax | 301-486-7581
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Authorized Official
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Title or Position | PARTNER
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Name | GIRISH SADASHIVA RAO
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Credential | MD
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Telephone | 301-452-7945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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