Provider Demographics
NPI:1003850850
Name:CENTER FOR RETINAL DISEASES AND SURGERY, LLC
Entity type:Organization
Organization Name:CENTER FOR RETINAL DISEASES AND SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-571-2000
Mailing Address - Street 1:6420 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 4900
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7837
Mailing Address - Country:US
Mailing Address - Phone:301-571-2000
Mailing Address - Fax:301-571-4307
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 4900
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-571-2000
Practice Address - Fax:301-571-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044710207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4332262OtherAETNA
330652OtherMDIPA, OPT CHOICE, MAMSI
MDLW08OtherCAREFIRST
DC7457OtherCAREFIRST
F58123Medicare UPIN
G00698Medicare ID - Type Unspecified