Provider Demographics
NPI:1700198900
Name:ROY LEIBOFF, MD & GEORGE BREN, MD, PC
Entity Type:Organization
Organization Name:ROY LEIBOFF, MD & GEORGE BREN, MD, PC
Other - Org Name:ROY LEIBOFF, MD & GEORGE BREN, MD, PC AT LAKESIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-868-8024
Mailing Address - Street 1:10403 HOSPITAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3134
Mailing Address - Country:US
Mailing Address - Phone:240-244-5151
Mailing Address - Fax:240-244-5131
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:SUITE 314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-785-4966
Practice Address - Fax:202-728-0905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROY LEIBOFF, MD & GEORGE BREN, MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1760714935OtherGROUP NPI FOR DC LOCATION