MEDICARE: DR. LIBUSE HEINZ-MOMCILOVIC MD

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	207RP1001X	Pulmonary Disease Physician	D0058542	MD

General Provider Information

NPI Number	:	1952305740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIBUSE HEINZ-MOMCILOVIC MD

Provider Business Mailing Address
First Line	:	10605 CONCORD ST
Second Line	:	STE. 500
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2504
Country	:	US
Telephone Number	:	301-942-2977
Fax Number	:	301-942-8031

Provider Business Practice Location Address
First Line	:	16220 FREDERICK RD
Second Line	:	STE 213
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-4039
Country	:	US
Telephone Number	:	301-942-2977
Fax Number	:	301-942-8031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/25/2009

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