Provider Demographics
NPI:1154753564
Name:ADAD COMPLEX MEDICAL
Entity type:Organization
Organization Name:ADAD COMPLEX MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:DAWNIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILBY-ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-257-5145
Mailing Address - Street 1:7708 MYSTIC RIVER TER
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9715
Mailing Address - Country:US
Mailing Address - Phone:301-257-5145
Mailing Address - Fax:
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-574-6855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036046207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty