1548070881 NPI number — SOUTHERN MARYLAND MEDICAL GROUP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548070881 NPI number — SOUTHERN MARYLAND MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MARYLAND MEDICAL GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548070881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 GREENWAY CENTER DR STE 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-486-7580
Provider Business Mailing Address Fax Number:
301-486-7581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 GREENWAY CENTER DR STE 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-486-7580
Provider Business Practice Location Address Fax Number:
301-486-7581
Provider Enumeration Date:
01/09/2025

Additional Information

Authorized Official

Authorized Official Last Name:
RAO
Authorized Official First Name:
GIRISH
Authorized Official Middle Name:
SADASHIVA
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
301-452-7945

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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