MEDICARE: PRIMARY CARE OF GERMANTOWN,LC

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	261QP2300X	Primary Care Clinic/Center	D0061696	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150491ZDG4	OTHER	MD	MEDICARE GROUP PROVIDER NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1861517336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE OF GERMANTOWN,LC

Provider Business Mailing Address
First Line	:	6 EXECUTIVE PARK CT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2645
Country	:	US
Telephone Number	:	301-515-9160
Fax Number	:	301-515-7388

Provider Business Practice Location Address
First Line	:	6 EXECUTIVE PARK CT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2645
Country	:	US
Telephone Number	:	301-515-9160
Fax Number	:	301-515-7388

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	DR. SHARON XIAO-CHUN YANG
Credential	:	MD
Telephone Number	:	240-688-6949

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/01/2011

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Directions to “PRIMARY CARE OF GERMANTOWN,LC ” Practice Location

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