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General NPI Number Information
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NPI Number | 1215892757
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DIABETES CENTER LLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 6510 KENILWORTH AVE STE 1200
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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 | 301-927-7750
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Fax | 240-582-7411
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Provider Business Mailing Address
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Address Line | 6510 KENILWORTH AVE STE 1200
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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 |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | INGEBORG JACKS-CURTIS
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Credential |
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Telephone | 301-873-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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