1013325125 NPI number — MONTGOMERY WOMEN'S MEDICAL CENTER, P.C.

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 1013325125 NPI number — MONTGOMERY WOMEN'S MEDICAL CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY WOMEN'S MEDICAL CENTER, P.C.
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:
1013325125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3202 TOWER OAKS BLVD
Provider Second Line Business Mailing Address:
SUITE # 370
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-4219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-946-6962
Provider Business Mailing Address Fax Number:
301-946-6022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3202 TOWER OAKS BLVD
Provider Second Line Business Practice Location Address:
SUITE # 370
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-946-6962
Provider Business Practice Location Address Fax Number:
301-946-6022
Provider Enumeration Date:
08/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FAMUYIWA
Authorized Official First Name:
OLUYEMISI
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-946-6962

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  D0044906 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 676300600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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