Provider Demographics
NPI:1104404813
Name:3RDROOM ENTERPRISES
Entity type:Organization
Organization Name:3RDROOM ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SORELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-781-0585
Mailing Address - Street 1:1506 DANWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3230
Mailing Address - Country:US
Mailing Address - Phone:718-781-0585
Mailing Address - Fax:754-212-0473
Practice Address - Street 1:7100 CHESAPEAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2353
Practice Address - Country:US
Practice Address - Phone:718-781-0585
Practice Address - Fax:754-212-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty