Provider Demographics
NPI:1306975461
Name:BETHESDA ENT ALLERGY CENTER, LLC
Entity type:Organization
Organization Name:BETHESDA ENT ALLERGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIEPERGERDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-360-0525
Mailing Address - Street 1:4550 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 733N
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3304
Mailing Address - Country:US
Mailing Address - Phone:301-656-6452
Mailing Address - Fax:
Practice Address - Street 1:4550 MONTGOMERY AVE
Practice Address - Street 2:SUITE 733N
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3304
Practice Address - Country:US
Practice Address - Phone:301-656-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043074261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42049Medicare UPIN