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Organization
BETHESDA RETINA,LLC
Active
Organization
BETHESDA RETINA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVAS M SASTRY M.D. (OWNER)
(301) 843-9971
Entity
Organization
Contact information
Practice address
10215 FERNWOOD RD, SUITE 305, BETHESDA, MD 20817-1106
(301) 896-0101
Mailing address
P.O. BOX 1375, WALDORF, MD 20604
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1277702
UNITED HEALTHCARE
—
01
—
349918
ALLIANCE
—
05
—
486910900
—
MD
Enumeration date
12/15/2009
Last updated
12/15/2009
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