| NPI | 1285760199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY FOSTER Office Manager 301-540-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MD D0055283) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0057921) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-03-14 |