1770512758 NPI number — METRO MEDICAL ASSOCIATES,INC

Table of content: (NPI 1770512758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770512758 NPI number — METRO MEDICAL ASSOCIATES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO MEDICAL ASSOCIATES,INC
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:
1770512758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1612 GRACE CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-587-4585
Provider Business Mailing Address Fax Number:
301-585-4564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7603 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20012-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-726-5014
Provider Business Practice Location Address Fax Number:
202-882-8209
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIXON
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
301-442-8889

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD14127 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD14127 . This is a "DC LICENSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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