Provider Demographics
NPI:1326450156
Name:MEDSTAR MEDICAL GROUP RADIOLOGY, LLC
Entity Type:Organization
Organization Name:MEDSTAR MEDICAL GROUP RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-902-1073
Mailing Address - Street 1:2331 BROADBIRCH DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1934
Mailing Address - Country:US
Mailing Address - Phone:301-902-1073
Mailing Address - Fax:301-902-1086
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:301-902-1073
Practice Address - Fax:301-902-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDV0411OtherRR MEDICARE
MD452303200Medicaid
DC075528800Medicaid
MDDV0409OtherRR MEDICARE
MD359304Medicare PIN
DC359662Medicare PIN