Provider Demographics
NPI:1790741759
Name:MONTGOMERY INFECTIOUS DISEASE ASSOCIATES,PA
Entity Type:Organization
Organization Name:MONTGOMERY INFECTIOUS DISEASE ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-588-3322
Mailing Address - Street 1:8630 FENTON STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-588-2525
Mailing Address - Fax:301-588-3447
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-588-2525
Practice Address - Fax:301-588-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD178045Medicare PIN