Provider Demographics
NPI:1417737321
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMEELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:JM-HL, MPH, MBA-HCM
Authorized Official - Phone:571-320-0150
Mailing Address - Street 1:3100 MEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2225
Mailing Address - Country:US
Mailing Address - Phone:240-740-1770
Mailing Address - Fax:301-929-2042
Practice Address - Street 1:3100 MEDWAY STREET (DENTAL)
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2225
Practice Address - Country:US
Practice Address - Phone:240-740-1770
Practice Address - Fax:301-929-2042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental