Organization
MGMC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE SCHNEIDER (VP)
(703) 558-1403
Entity
Organization
Contact information
Practice address
3800 RESERVOIR RD NW, WASHINGTON, DC 20007-2113
(888) 896-1400
Mailing address
PO BOX 418283, BOSTON, MA 02241-8283
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027332900
—
DC
05
—
220004006
—
MD
01
—
6555
BLUE SHIELD GROUP NUMBER
DC
01
—
W676
BLUE SHIELD PEDS PCP GRP#
DC
01
—
W678
BLUESHIELD ADULT PCP GRP#
DC
Enumeration date
06/01/2005
Last updated
03/28/2024
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