Basic Information
| Provider Information | |||||||||
| NPI: | 1609007095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVENTIST PHYSICIAN SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 WEST DIAMOND AVENUE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013153826 | ||||||||
| FaxNumber: | 3013153728 | ||||||||
| Practice Location | |||||||||
| Address1: | 9909 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408646007 | ||||||||
| FaxNumber: | 2408646125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2009 | ||||||||
| LastUpdateDate: | 07/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | LINFORD | ||||||||
| AuthorizedOfficialFirstName: | FRAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3013153826 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.