Provider Demographics
NPI:1497188601
Name:PREMIER REHABILITATION MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PREMIER REHABILITATION MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:PERKINS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-499-8092
Mailing Address - Street 1:12505 DORSEY LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5374
Mailing Address - Country:US
Mailing Address - Phone:410-499-8092
Mailing Address - Fax:301-868-4446
Practice Address - Street 1:12505 DORSEY LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5374
Practice Address - Country:US
Practice Address - Phone:410-499-8092
Practice Address - Fax:301-868-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066461208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty