Provider Demographics
NPI:1609967736
Name:OLNEY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:OLNEY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-774-5555
Mailing Address - Street 1:18213 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1422
Mailing Address - Country:US
Mailing Address - Phone:301-774-5400
Mailing Address - Fax:
Practice Address - Street 1:18109 PRINCE PHILIP DR STE 275
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1576
Practice Address - Country:US
Practice Address - Phone:301-774-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058291300Medicaid
MD058291300Medicaid
MDF40602Medicare UPIN
MD536714Medicare ID - Type Unspecified