Basic Information
| Provider Information | |||||||||
| NPI: | 1568792059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SILVER SPRING MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11006 VEIRS MILL RD # L15-282 | ||||||||
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| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209022582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11301 AMHERST AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209024665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2010 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | STARR | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 3019337827 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6463990001 | 01 | MEDICARE NSC | OTHER |