MEDICARE: GREENBELT OCCUPATIONAL MEDICAL SERVICES

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	174400000X	Specialist

General Provider Information

NPI Number	:	1063663425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBELT OCCUPATIONAL MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	7933 BELLE POINT DR
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3329
Country	:	US
Telephone Number	:	301-220-1191
Fax Number	:	301-220-2291

Provider Business Practice Location Address
First Line	:	7933 BELLE POINT DR
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3329
Country	:	US
Telephone Number	:	301-220-1191
Fax Number	:	301-220-2291

Authorized Official
Title or Position	:	CHEIF OPERATING OFFICER
Name	:	MR. WILL PHILLIPS
Credential	:	C.O.O.
Telephone Number	:	443-524-2737

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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