Basic Information
| Provider Information | |||||||||
| NPI: | 1558099697 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RETINA GROUP OF WASHINGTON, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MOUNTAIN AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | NEW PROVIDENCE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079742736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 E PULASKI HWY STE 1 | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219216457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106203600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2022 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | MADREPERLA | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9084588313 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD, PHD | ||||||||
| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.