Provider Demographics
NPI:1417298209
Name:BETHESDA ALLERGY, ASTHMA, AND RESEARCH CENTER, LLC
Entity Type:Organization
Organization Name:BETHESDA ALLERGY, ASTHMA, AND RESEARCH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-907-3442
Mailing Address - Street 1:4915 AUBURN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2636
Mailing Address - Country:US
Mailing Address - Phone:301-907-3442
Mailing Address - Fax:301-907-6835
Practice Address - Street 1:4915 AUBURN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2636
Practice Address - Country:US
Practice Address - Phone:301-907-3442
Practice Address - Fax:301-907-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty