Provider Demographics
NPI:1588207757
Name:REGENMD LLC
Entity Type:Organization
Organization Name:REGENMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:240-552-6200
Mailing Address - Street 1:7811 MONTROSE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3363
Mailing Address - Country:US
Mailing Address - Phone:240-552-6200
Mailing Address - Fax:
Practice Address - Street 1:7811 MONTROSE RD STE 330
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3363
Practice Address - Country:US
Practice Address - Phone:240-552-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty