# BETHESDA RETINA,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790014082
- **Authorized official:** DR. SRINIVAS M SASTRY M.D. (OWNER)
- **Authorized official phone:** (301) 843-9971

## Contact information

- **Practice address:** 10215 FERNWOOD RD, SUITE 305, BETHESDA, MD 20817-1106
- **Practice address phone:** (301) 896-0101
- **Mailing address:** P.O. BOX 1375, WALDORF, MD 20604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/15/2009
- **Last updated:** 12/15/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1277702 | UNITED HEALTHCARE | — |
| 01 | — | 349918 | ALLIANCE | — |
| 05 | — | 486910900 | — | MD |