# LEGACY PHYSIATRY GROUP MARYLAND, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Physiatry Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669869939
- **Authorized official:** MARILYN J MEARON (BILLING MANAGER)
- **Authorized official phone:** (972) 881-4688

## Contact information

- **Practice address:** 9711 WASHINGTONIAN BLVD STE 550, GAITHERSBURG, MD 20878-5789
- **Practice address phone:** (972) 881-4688
- **Practice address fax:** (972) 372-1657
- **Mailing address:** 850 CENTRAL PKWY E STE 275, PLANO, TX 75074-5542
- **Mailing address phone:** (972) 881-4688
- **Mailing address fax:** (972) 372-1657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/23/2015
- **Last updated:** 10/27/2023