1578770160 NPI number — WOMEN'S HEALTH SPECIALISTS OF MONTGOMERY COUNTY, LLC

Table of content: (NPI 1578770160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578770160 NPI number — WOMEN'S HEALTH SPECIALISTS OF MONTGOMERY COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S HEALTH SPECIALISTS OF MONTGOMERY COUNTY, 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:
WOMEN'S HEALTH SPECIALISTS OF MONTGOMERY COUNTY, LLC
Provider Other Organization Name Type Code:
3
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:
1578770160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 EXECUTIVE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-770-4967
Provider Business Mailing Address Fax Number:
301-770-3205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 EXECUTIVE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-770-4967
Provider Business Practice Location Address Fax Number:
301-770-3205
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEREN
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
SNYDER
Authorized Official Title or Position:
OWNER MANAGING PHYSICIAN
Authorized Official Telephone Number:
301-770-4967

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: C0001760 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: R126791 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1578770160 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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