MEDICARE: NORTHERNGATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1033931175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERNGATE

Provider Business Mailing Address
First Line	:	8650 GEORGIA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3404
Country	:	US
Telephone Number	:	301-589-7474
Fax Number	:	301-589-7159

Provider Business Practice Location Address
First Line	:	8650 GEORGIA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3404
Country	:	US
Telephone Number	:	301-589-7474
Fax Number	:	301-589-7159

Authorized Official
Title or Position	:	MANAGER
Name	:	PATRICIA PARKS
Credential	:
Telephone Number	:	517-231-4086

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	04/24/2026

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Directions to “NORTHERNGATE ” Practice Location

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