| NPI | 1912458621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE SIMMONS Office Manager 301-705-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MD S03581) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2017-02-28 |