1700198900 NPI number — ROY LEIBOFF, MD & GEORGE BREN, MD, PC

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 1700198900 NPI number — ROY LEIBOFF, MD & GEORGE BREN, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROY LEIBOFF, MD & GEORGE BREN, MD, PC
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:
6
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:
1700198900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10403 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-244-5151
Provider Business Mailing Address Fax Number:
240-244-5131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 M ST NW
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-785-4966
Provider Business Practice Location Address Fax Number:
202-728-0905
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SYLVESTER
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR OF FINANCE AND BILLING
Authorized Official Telephone Number:
301-868-8024

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1760714935 . This is a "GROUP NPI FOR DC LOCATION" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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