MEDICARE: METRO IPC SILVER SPRING, 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	207Q00000X	Family Medicine Physician	MD20115	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356612279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO IPC SILVER SPRING, LLC

Provider Business Mailing Address
First Line	:	8484 GEORGIA AVE
Second Line	:	SUITE 1
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5604
Country	:	US
Telephone Number	:	202-641-4155
Fax Number	:	301-263-7761

Provider Business Practice Location Address
First Line	:	8484 GEORGIA AVE
Second Line	:	SUITE 1
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5604
Country	:	US
Telephone Number	:	202-641-4155
Fax Number	:	301-263-7761

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHRISTOPHER TIMM
Credential	:
Telephone Number	:	202-641-4155

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	11/23/2012

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