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NPI Code Detail

MEDICARE: 7525 CARROLL AVENUE OPERATIONS LLC

MEDICARE: 7525 CARROLL AVENUE OPERATIONS 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
1225X00000XOccupational Therapist15027MD
2225100000XPhysical Therapist15027MD

Other Identifiers

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

General Provider Information

NPI Number : 1356795728
Entity Type Code : Organization
Provider Name (Legal Business Name) : 7525 CARROLL AVENUE OPERATIONS LLC
Provider Business Mailing Address
First Line : 7525 CARROLL AVE
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-5715
Country : US
Telephone Number : 301-270-4200
Fax Number :
Provider Business Practice Location Address
First Line : 7525 CARROLL AVE
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-5715
Country : US
Telephone Number : 301-270-4200
Fax Number :
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 04/21/2016
Last Update Date : 09/07/2017

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