Basic Information
| Provider Information | |||||||||
| NPI: | 1982699815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASBURY PHYSICIAN SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 RUSSELL AVE | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208772801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012164157 | ||||||||
| FaxNumber: | 3019876297 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 RUSSELL AVE | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208772801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012164157 | ||||||||
| FaxNumber: | 3019876297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BIRSCHBACH | ||||||||
| AuthorizedOfficialFirstName: | H ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3012164157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207N00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207X00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208100000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207RC0001X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 133V00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 363LF0000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 213E00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 231H00000X | MD | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 3078653001 | 01 | CIGNA | OTHER | 5297 | 01 | DC | CAREFIRST | OTHER | 340AAS | 01 | MD | CAREFIRST MD- SPEC | OTHER | KG99AAS | 01 | MD | CAREFIRST MD- PCPS | OTHER |