NPI 1952543191

Type 1 Individual Provider

Organisation Exclusive Provider Organization Silver Spring, MD

Practice location

Address: 1620 Elton Rd, Silver Spring, MD 20903-1740
Phone: (301) 439-7191

Authorised official

Name: Brena Gibson
Title: Human Resources Director
Phone: (301) 439-7191

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence LC2381 (MD)

Other Exclusive Provider Organization providers in Maryland →

Registry record

NPI: 1952543191
Entity type: Organization
NPI issued: 2 Apr 2009
Record last updated: 8 Apr 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.