Type 1 Individual Provider
TYPE 1 INDIVIDUAL PROVIDER official legal name TYPE 1 INDIVIDUAL PROVIDER is located at 1620 ELTON RD, Silver Spring, Maryland. TYPE 1 INDIVIDUAL PROVIDER primary taxonomy is Exclusive Provider Organization in the state of Maryland.
| Organization Legal Name | TYPE 1 INDIVIDUAL PROVIDER |
| Organization Other Name | TYPE 1 INDIVIDUAL PROVIDER |
| NPI | 1952543191 |
| City | Silver Spring |
| State | Maryland |
| Address 1 | 1620 ELTON RD |
| Postal Code | 20903 |
| Phone | 3014397191 |
Related medical specializations
| Taxonomy ID | Grouping | Classification | Specialization |
|---|---|---|
| 302F00000X | Managed Care Organizations | Exclusive Provider Organization |