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

Table of content: (NPI 1700198900)

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:
ROY LEIBOFF, MD & GEORGE BREN, MD, PC AT LAKESIDE
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:
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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