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General NPI Number Information
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NPI Number | 1437317955
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE OF GAITHERSBURG
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 981 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20879-6219
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Country | US
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Telephone | 301-740-8732
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Fax |
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Provider Business Mailing Address
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Address Line | 981 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20879-6219
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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 | DIR OF OPERATIONS
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Name | CARYL MATTHEW
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Credential |
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Telephone | 301-216-2065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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