Provider Demographics
NPI:1699906594
Name:ODE MEDICAL LLC
Entity type:Organization
Organization Name:ODE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIMISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-873-2529
Mailing Address - Street 1:14725 JAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-7410
Mailing Address - Country:US
Mailing Address - Phone:301-989-0651
Mailing Address - Fax:301-384-1083
Practice Address - Street 1:6323 GEORGIA AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1101
Practice Address - Country:US
Practice Address - Phone:202-291-1148
Practice Address - Fax:202-291-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD16434261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical