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General NPI Number Information
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NPI Number | 1790014082
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Entity Type | Organization
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Legal Business Name | BETHESDA RETINA,LLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD SUITE 305
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 301-896-0101
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1375
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City | WALDORF
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State | MD
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Zip | 20604
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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 | OWNER
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Name | DR. SRINIVAS M SASTRY
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Credential | M.D.
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Telephone | 301-843-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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