Provider Demographics
NPI:1639334865
Name:BETHESDA ALLERGY & ASTHMA CLINIC, LLC
Entity Type:Organization
Organization Name:BETHESDA ALLERGY & ASTHMA CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:IRONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-564-4090
Mailing Address - Street 1:10401 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE #407
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1911
Mailing Address - Country:US
Mailing Address - Phone:301-564-4090
Mailing Address - Fax:
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE #407
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:301-564-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty