MEDICARE: AMERICAN DIVERSITY GROUP INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1427813989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DIVERSITY GROUP INC

Provider Business Mailing Address
First Line	:	21204 DORSEY SPRING PL
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-6923
Country	:	US
Telephone Number	:	240-330-9421
Fax Number	:	240-293-3784

Provider Business Practice Location Address
First Line	:	12210 PLUM ORCHARD DR STE 214
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7913
Country	:	US
Telephone Number	:	240-330-9421
Fax Number	:	240-293-3784

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MAYUR MODY
Credential	:
Telephone Number	:	240-330-9421

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	10/07/2024

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