Provider Demographics
NPI:1689843971
Name:PULMONARY AND CRITICAL CARE ASSOCIATES OF SOUTHERN MARYLAND LLC
Entity Type:Organization
Organization Name:PULMONARY AND CRITICAL CARE ASSOCIATES OF SOUTHERN MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:OMAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-751-5351
Mailing Address - Street 1:6 POST OFFICE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2746
Mailing Address - Country:US
Mailing Address - Phone:301-751-5351
Mailing Address - Fax:
Practice Address - Street 1:6 POST OFFICE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2746
Practice Address - Country:US
Practice Address - Phone:301-751-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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