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General NPI Number Information
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NPI Number | 1245636455
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Entity Type | Organization
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Legal Business Name | MENON MEDICAL CENTER LLC
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Dates
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Enumeration Date | 11/15/2014
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 10605 CONCORD ST SUITE 300
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City | KENSINGTON
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State | MD
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Zip | 20895-2504
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Country | US
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Telephone | 301-942-9833
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Fax | 301-942-9837
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Provider Business Mailing Address
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Address Line | PO BOX 645
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City | KENSINGTON
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State | MD
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Zip | 20895-0645
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Country | US
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Telephone | 301-942-9833
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Fax | 301-942-9837
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROJI MENON
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Credential | MD
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Telephone | 301-942-9833
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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 | D0057879
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License Number State | MD
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