MEDICARE: MONTGOMERY COUNTY MARYLAND GOVERNMENT

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	207RI0200X	Infectious Disease Physician
2	261QP0905X	State or Local Public Health Clinic/Center

General Provider Information

NPI Number	:	1912750290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY COUNTY MARYLAND GOVERNMENT

Provider Business Mailing Address
First Line	:	12900 MIDDLEBROOK RD
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2672
Country	:	US
Telephone Number	:	240-777-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 MIDDLEBROOK RD STE 24
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2672
Country	:	US
Telephone Number	:	240-777-1609
Fax Number	:

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	DIANA AZUCENA CORTEZ
Credential	:
Telephone Number	:	240-672-6758

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	01/15/2026

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