Provider Demographics
NPI:1467173203
Name:MARYLAND MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MARYLAND MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-780-4745
Mailing Address - Street 1:10110 MOLECULAR DR STE 114
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7538
Mailing Address - Country:US
Mailing Address - Phone:301-780-4745
Mailing Address - Fax:301-605-7550
Practice Address - Street 1:10110 MOLECULAR DRIVE
Practice Address - Street 2:SUITE 114
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7542
Practice Address - Country:US
Practice Address - Phone:301-780-4745
Practice Address - Fax:301-605-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty