Basic Information
| Provider Information | |||||||||
| NPI: | 1285064550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MGMC, LLC | ||||||||
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| OtherOrganizationName: | MEDSTAR ORTHOPAEDIC INSTITUTE AT BRANDYWINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 15TH ST N | ||||||||
| Address2: | STE. 600 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222012683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888961400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13950 BRANDYWINE RD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BRANDYWINE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206135815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017822220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2013 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 7035581403 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MGMC, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.