Provider Demographics
NPI:1659396703
Name:FAMILY ENT ALLERGY AND ASTHMA CENTER PC
Entity Type:Organization
Organization Name:FAMILY ENT ALLERGY AND ASTHMA CENTER PC
Other - Org Name:FAMILY ALLERGY & ASTHMA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-948-4066
Mailing Address - Street 1:806 W DIAMOND AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1415
Mailing Address - Country:US
Mailing Address - Phone:301-948-4066
Mailing Address - Fax:301-963-2283
Practice Address - Street 1:806 W DIAMOND AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1415
Practice Address - Country:US
Practice Address - Phone:301-948-4066
Practice Address - Fax:301-963-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ41991Medicare UPIN
MDB94106Medicare UPIN
MDH42724Medicare UPIN