Provider Demographics
NPI:1427813989
Name:AMERICAN DIVERSITY GROUP INC
Entity type:Organization
Organization Name:AMERICAN DIVERSITY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-330-9421
Mailing Address - Street 1:21204 DORSEY SPRING PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6923
Mailing Address - Country:US
Mailing Address - Phone:240-330-9421
Mailing Address - Fax:240-293-3784
Practice Address - Street 1:12210 PLUM ORCHARD DR STE 214
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7913
Practice Address - Country:US
Practice Address - Phone:240-330-9421
Practice Address - Fax:240-293-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty