Organization
MONTGOMERY RENAL CENTER LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEISTER CORTELING (ADMINISTRATOR)
(240) 361-0625
Entity
Organization
Contact information
Practice address
12401 MIDDLEBROOK RD, STE 160, GERMANTOWN, MD 20874-1523
(301) 540-6020
(301) 540-6030
Mailing address
12401 MIDDLEBROOK RD, STE 160, GERMANTOWN, MD 20874-1523
(301) 540-6020
(301) 540-6030
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2625
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400446900
—
MD
Enumeration date
06/17/2005
Last updated
05/25/2011
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