Provider Demographics
NPI:1063692291
Name:PATUXENT RHEUMATOLOGY ASSOCIATES,LLC
Entity type:Organization
Organization Name:PATUXENT RHEUMATOLOGY ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-414-3437
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0424
Mailing Address - Country:US
Mailing Address - Phone:410-414-3437
Mailing Address - Fax:410-414-3451
Practice Address - Street 1:995 N. PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3151
Practice Address - Country:US
Practice Address - Phone:410-414-3437
Practice Address - Fax:410-414-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059442207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2121894OtherFELRA & GEHA
MD408633300Medicaid
MD7253531OtherAETNA
MD395A-PAOtherCAREFIRST
MDJ527OtherBLUE CHOICE AND FED
MD660MMedicare PIN
MD2121894OtherFELRA & GEHA