Organization
GROGAN HEALTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA TANNEBAUM M.D (PRESIDENT)
(301) 251-0099
Entity
Organization
Contact information
Practice address
1400 FOREST GLEN RD, SUITE 225, SILVER SPRING, MD 20910-1459
(301) 754-7571
(301) 754-3171
Mailing address
8624 WILD OLIVE DR, POTOMAC, MD 20854-3438
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
479091000
—
MD
Enumeration date
03/22/2012
Last updated
03/22/2012
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