MEDICARE: FAMILY HEALTH CARE OF SILVER SPRING

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	D39997	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54322302	OTHER	MD	BCBS OF MD
2	78072	OTHER	MD	AMERIGROUP

General Provider Information

NPI Number	:	1750560397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CARE OF SILVER SPRING

Provider Business Mailing Address
First Line	:	344 UNIVERSITY BLVD W STE 213
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1970
Country	:	US
Telephone Number	:	301-592-1784
Fax Number	:	301-592-1783

Provider Business Practice Location Address
First Line	:	344 UNIVERSITY BLVD W STE 213
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1970
Country	:	US
Telephone Number	:	301-592-1784
Fax Number	:	301-592-1783

Authorized Official
Title or Position	:	OWNER
Name	:	MONA ELLIS
Credential	:	MD
Telephone Number	:	301-592-1784

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	11/09/2007

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Directions to “FAMILY HEALTH CARE OF SILVER SPRING ” Practice Location

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