| NPI | 1790177210 |
|---|---|
| Former Legal Business Name | SHADY GROVE DERMATOLOGY, LLC |
| Entity Type | Organization |
| Authorized Contact | SANDEE HALL DAVIDSON Business Consultant 240-246-7417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0028453) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2024-03-05 |