Provider Demographics
NPI:1124474507
Name:MEDSTAR HEALTH AT BRANDYWINE
Entity type:Organization
Organization Name:MEDSTAR HEALTH AT BRANDYWINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-877-4564
Mailing Address - Street 1:13950 BRANDYWINE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5815
Mailing Address - Country:US
Mailing Address - Phone:301-782-2220
Mailing Address - Fax:301-782-2221
Practice Address - Street 1:13950 BRANDYWINE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5815
Practice Address - Country:US
Practice Address - Phone:301-782-2220
Practice Address - Fax:301-782-2221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR AMBULATORY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty