Organization
FAMILY MEDICINE OF GAITHERSBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARYL MATTHEW (DIR OF OPERATIONS)
(301) 216-2065
Entity
Organization
Contact information
Practice address
981 RUSSELL AVE, GAITHERSBURG, MD 20879-6219
(301) 740-8732
Mailing address
981 RUSSELL AVE, GAITHERSBURG, MD 20879-6219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002760000
—
MD
Enumeration date
05/30/2008
Last updated
05/30/2008
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