Basic Information
| Provider Information | |||||||||
| NPI: | 1699842609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER WASHINGTON SLEEP DISORDERS CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 RESEARCH BLVD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012515905 | ||||||||
| FaxNumber: | 3012519137 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 RESEARCH BLVD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012515905 | ||||||||
| FaxNumber: | 3012519137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DIPIETRO | ||||||||
| AuthorizedOfficialFirstName: | LORRAINE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3012515905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | LW38GR | 01 | MD | BLUE SHIELD | OTHER | 461867 | 01 | AETNA HMO | OTHER | 8740013 | 01 | AETNA PPO | OTHER | 240041 | 01 | MD | MAMSI | OTHER |