Provider Demographics
NPI:1568808012
Name:INTERDYANMICS,INC.
Entity Type:Organization
Organization Name:INTERDYANMICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PROJECT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-306-4590
Mailing Address - Street 1:4601 FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4807
Mailing Address - Country:US
Mailing Address - Phone:301-306-4590
Mailing Address - Fax:301-306-4591
Practice Address - Street 1:4601 FORBES BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4807
Practice Address - Country:US
Practice Address - Phone:301-306-4590
Practice Address - Fax:301-306-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty