Provider Demographics
NPI:1447560016
Name:BETHESDA MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BETHESDA MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CMPE
Authorized Official - Phone:301-493-9320
Mailing Address - Street 1:10215 FERNWOOD ROAD SUITE 100A
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-493-9607
Mailing Address - Fax:301-439-5532
Practice Address - Street 1:10215 FERNWOOD RD STE 50
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1174
Practice Address - Country:US
Practice Address - Phone:301-493-9320
Practice Address - Fax:301-439-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty