Provider Demographics
NPI:1285180448
Name:DECALO MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:DECALO MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-567-2557
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-567-2557
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty