Provider Demographics
NPI:1922395581
Name:MMG - GEORGETOWN FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:MMG - GEORGETOWN FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-558-1403
Mailing Address - Street 1:PO BOX 418681
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 115
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4300
Practice Address - Country:US
Practice Address - Phone:202-237-0015
Practice Address - Fax:202-237-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC227134Medicare PIN