Provider Demographics
NPI:1124889811
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:AZUCENA
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-773-1211
Mailing Address - Street 1:401 HUNGERFORD DR FL 6
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4154
Mailing Address - Country:US
Mailing Address - Phone:240-777-4520
Mailing Address - Fax:
Practice Address - Street 1:20301 BRANDERMILL DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-5644
Practice Address - Country:US
Practice Address - Phone:240-740-0600
Practice Address - Fax:301-353-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local