Organization
SPAA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN GRAGNOLATI (CEO)
(301) 896-2574
Entity
Organization
Contact information
Practice address
8600 OLD GEORGETOWN RD, BETHESDA, MD 20814-1422
(301) 896-3100
Mailing address
SUBURBAN PHYSICIAN ASSISTANT, PO BOX 79050, BALTIMORE, MD 21279-0001
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
R119344
MD
Other
Enumeration date
12/16/2008
Last updated
12/16/2008
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