Provider Demographics
NPI:1740571801
Name:NORTH BETHESDA MEDICAL CLINIC
Entity Type:Organization
Organization Name:NORTH BETHESDA MEDICAL CLINIC
Other - Org Name:NORTH BETHESDA MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZISCOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-881-2920
Mailing Address - Street 1:11400 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3004
Mailing Address - Country:US
Mailing Address - Phone:301-881-2920
Mailing Address - Fax:301-881-2921
Practice Address - Street 1:11400 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 511
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3004
Practice Address - Country:US
Practice Address - Phone:301-881-2920
Practice Address - Fax:301-881-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty