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General NPI Number Information
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NPI Number | 1366489783
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Entity Type | Organization
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Legal Business Name | SHADY GROVE HYPERBARIC MEDICINE
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 9901 MEDICAL CENTER DR
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City | ROCKVILLE
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State | MD
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Zip | 20850-3357
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Country | US
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Telephone | 301-279-6550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 856
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City | FREDERICK
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State | MD
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Zip | 21705-0856
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Country | US
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Telephone | 240-364-2515
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JOEL BUZY
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Credential | MD
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Telephone | 240-826-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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