Provider Demographics
NPI:1184641078
Name:ADVENTIST PHYSICIAN SERVICES (SGAH)
Entity Type:Organization
Organization Name:ADVENTIST PHYSICIAN SERVICES (SGAH)
Other - Org Name:ADVENTIST PHYSICIAN SERVICES - SGAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-442-2400
Mailing Address - Street 1:PO BOX 64742-01
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4742
Mailing Address - Country:US
Mailing Address - Phone:614-442-2400
Mailing Address - Fax:614-442-2403
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:614-442-2400
Practice Address - Fax:614-442-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty