{
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"LastName": null,
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"FirstLineMailingAddress": "2108 CARTER MILL WAY",
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"MailingAddressCityName": "BROOKEVILLE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20833-3203",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10551 METROPOLITAN AVE",
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"PracticeLocationAddressCityName": "KENSINGTON",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressTelephoneNumber": "301-452-4226",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/02/2017",
"LastUpdateDate": "02/16/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABRAHAM",
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"AuthorizedOfficialTelephoneNumber": "301-452-4226",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Point of Service",
"LicenseNumber": "21250",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}