MEDICARE: BETHESDA ENT ALLERGY CENTER, LLC

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	261QM2500X	Medical Specialty Clinic/Center	D0043074	MD

General Provider Information

NPI Number	:	1306975461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA ENT ALLERGY CENTER, LLC

Provider Business Mailing Address
First Line	:	4550 MONTGOMERY AVE
Second Line	:	SUITE 733N
City	:	BETHESDA
State	:	MD
Zip	:	20814-3304
Country	:	US
Telephone Number	:	301-656-6452
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 MONTGOMERY AVE
Second Line	:	SUITE 733N
City	:	BETHESDA
State	:	MD
Zip	:	20814-3304
Country	:	US
Telephone Number	:	301-656-6452
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JAMES C. PIEPERGERDES
Credential	:	MD
Telephone Number	:	202-360-0525

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/22/2020

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