Provider Demographics
NPI:1376736603
Name:ASSOCIATES IN FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:ASSOCIATES IN FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-622-6020
Mailing Address - Street 1:12210 PLUM ORCHARD DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7800
Mailing Address - Country:US
Mailing Address - Phone:301-622-6020
Mailing Address - Fax:301-680-9335
Practice Address - Street 1:12210 PLUM ORCHARD DR
Practice Address - Street 2:SUITE 212
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7800
Practice Address - Country:US
Practice Address - Phone:301-622-6020
Practice Address - Fax:301-680-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0546781OtherAETNA
MD0546781OtherAETNA