Organization
9701 MEDICAL CENTER DRIVE OPERATIONS LLC
Active
Other names
Shady Grove Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
9701 MEDICAL CENTER DR, ROCKVILLE, MD 20850-3326
(301) 315-1900
Mailing address
9701 MEDICAL CENTER DR, ROCKVILLE, MD 20850-3326
(301) 315-1900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15009
MD
225X00000X
Occupational Therapist
15009
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
561102400
—
MD
Enumeration date
04/21/2016
Last updated
09/07/2017
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