Basic Information
| Provider Information | |||||||||
| NPI: | 1386691442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SILVER SPRING EMERGENCY PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17315 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212971315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432742900 | ||||||||
| FaxNumber: | 4432742391 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 FOREST GLEN RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209101483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017547000 | ||||||||
| FaxNumber: | 4432742391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | OUFIERO | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3017547000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4435 | 01 | DC | BCBS GROUP PROVIDER # | OTHER | KH67SI | 01 | MD | BCBS GROUP PROVIDER # | OTHER | 356702800 | 05 | MD | MEDICAID |