Provider Demographics
NPI:1528205408
Name:THE METROPOLITAN NEUROSURGERY GROUP LLC
Entity Type:Organization
Organization Name:THE METROPOLITAN NEUROSURGERY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRASER
Authorized Official - Middle Name:CUMMINS
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-654-9390
Mailing Address - Street 1:1010 WAYNE AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5655
Mailing Address - Country:US
Mailing Address - Phone:301-557-9049
Mailing Address - Fax:301-654-9394
Practice Address - Street 1:8401 CONNECTICUT AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-654-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044416174400000X
MD6742100001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD148366OtherPTAN
MD6742100001Medicare PIN