Provider Demographics
NPI:1578636858
Name:GREENBELT MEDICAL CENTER
Entity Type:Organization
Organization Name:GREENBELT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:RAIS
Authorized Official - Last Name:FARZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-441-1800
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE T3
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3527
Mailing Address - Country:US
Mailing Address - Phone:301-441-1800
Mailing Address - Fax:301-474-8979
Practice Address - Street 1:7525 GREENWAY CENTER DR STE T3
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3527
Practice Address - Country:US
Practice Address - Phone:301-441-1800
Practice Address - Fax:301-474-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5704OtherBLUE CROSS BLUE SHIELD
MDDG3845OtherRAILROAD/MEDICARE
MDOF31OtherCAREFIRST BCBS
MDDG3845OtherRAILROAD/MEDICARE
MDG01653Medicare PIN