Provider Demographics
NPI:1154400372
Name:DRS MAGGIN MARGOLIS MOY AND TADIKONDA LLC
Entity type:Organization
Organization Name:DRS MAGGIN MARGOLIS MOY AND TADIKONDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-490-1990
Mailing Address - Street 1:13952 BALTIMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-490-1990
Mailing Address - Fax:301-490-8750
Practice Address - Street 1:13952 BALTIMORE AVENUE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-490-1990
Practice Address - Fax:301-490-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD269511100Medicaid
7663OtherCAREFIRST
MD269511100Medicaid