Provider Demographics
NPI:1598879736
Name:RISAM AND RISAM, P.C.
Entity Type:Organization
Organization Name:RISAM AND RISAM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-249-4090
Mailing Address - Street 1:3060 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1389
Mailing Address - Country:US
Mailing Address - Phone:301-249-4090
Mailing Address - Fax:301-390-1344
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1389
Practice Address - Country:US
Practice Address - Phone:301-249-4090
Practice Address - Fax:301-390-1344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RISAM AND RISAM P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032769207Q00000X
MDD0032735207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKN97RIOtherBCBS MD GROUP NUMBER
MDG00628Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MDKN97RIOtherBCBS MD GROUP NUMBER