| NPI | 1730251802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE A STEWART Practice Administrator 301-681-2683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D08092) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC 4768) |
| 174400000X Specialist (Licence: MD D46443) | |
| 174400000X Specialist (Licence: CA G067028) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-08-22 |