Organization
REVITALIZE LLC
Active
Other names
Optimal Health Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORTON FISHMAN MD (MEDICAL DIRECTOR)
(301) 330-9430
Entity
Organization
Contact information
Practice address
15235 SHADY GROVE RD, SUITE 102, ROCKVILLE, MD 20850-3234
(301) 330-9430
(301) 330-6515
Mailing address
15235 SHADY GROVE RD, SUITE 102, ROCKVILLE, MD 20850-3234
(301) 330-9430
(301) 330-6515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
H67624
MD
207R00000X
Internal Medicine Physician
Primary
D0050126
MD
Other
Enumeration date
09/09/2011
Last updated
10/24/2011
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