Provider Demographics
NPI:1518312990
Name:MEDSTAR HEALTH AT BRANDYWINE
Entity Type:Organization
Organization Name:MEDSTAR HEALTH AT BRANDYWINE
Other - Org Name:MEDSTAR HEALTH AT BRANDYWINE / ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-877-4564
Mailing Address - Street 1:13950 BRANDYWINE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5815
Mailing Address - Country:US
Mailing Address - Phone:301-782-2220
Mailing Address - Fax:301-782-2221
Practice Address - Street 1:13950 BRANDYWINE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5815
Practice Address - Country:US
Practice Address - Phone:301-782-2220
Practice Address - Fax:301-782-2221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR AMBULATORY SERVICES, INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty