Provider Demographics
NPI:1285872762
Name:PEDIATRIC GASTROENTEROLOGY OF GREATER WASHINGTON
Entity type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY OF GREATER WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:REKHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-251-0520
Mailing Address - Street 1:2264 GLENMORE TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3051
Mailing Address - Country:US
Mailing Address - Phone:301-251-0520
Mailing Address - Fax:
Practice Address - Street 1:2264 GLENMORE TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3051
Practice Address - Country:US
Practice Address - Phone:301-251-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063257261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty