Provider Demographics
NPI:1083755797
Name:WOODMONT PSYCHIATRIC GROUP, LLC
Entity Type:Organization
Organization Name:WOODMONT PSYCHIATRIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-654-2255
Mailing Address - Street 1:7910 WOODMONT AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3002
Mailing Address - Country:US
Mailing Address - Phone:301-654-2255
Mailing Address - Fax:301-718-4945
Practice Address - Street 1:7910 WOODMONT AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3002
Practice Address - Country:US
Practice Address - Phone:301-654-2255
Practice Address - Fax:301-718-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
421337Medicare ID - Type Unspecified