Provider Demographics
NPI:1215747563
Name:SOUTHERN MARYLAND MEDICAL GROUP LLC
Entity type:Organization
Organization Name:SOUTHERN MARYLAND MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:SADASHIVA
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-452-7945
Mailing Address - Street 1:7500 GREENWAY CENTER DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3556
Mailing Address - Country:US
Mailing Address - Phone:301-486-7580
Mailing Address - Fax:301-486-7581
Practice Address - Street 1:6510 KENILWORTH AVE STE 1400
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1339
Practice Address - Country:US
Practice Address - Phone:301-618-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MARYLAND MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty