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General NPI Number Information
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NPI Number | 1447560016
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Entity Type | Organization
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Legal Business Name | BETHESDA MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD STE 50
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City | BETHESDA
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State | MD
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Zip | 20817-1174
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Country | US
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Telephone | 301-493-9320
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Fax | 301-439-5532
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Provider Business Mailing Address
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Address Line | 10215 FERNWOOD ROAD SUITE 100A
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City | BETHESDA
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State | MD
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Zip | 20817
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Country | US
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Telephone | 301-493-9607
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Fax | 301-439-5532
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. AMBER BLACKWELL
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Credential | RN, BSN, CMPE
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Telephone | 301-493-9320
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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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