Provider Demographics
NPI:1558848747
Name:ADVANCED GLAUCOMA EYECARE
Entity Type:Organization
Organization Name:ADVANCED GLAUCOMA EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'SOUZA-DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-917-2770
Mailing Address - Street 1:2308 CALVIN CIR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1802
Mailing Address - Country:US
Mailing Address - Phone:410-465-2435
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD STE 105
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:410-465-2435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty