Provider Demographics
NPI:1124263876
Name:ADVANCED WEIGHT LOSS SURGERY
Entity type:Organization
Organization Name:ADVANCED WEIGHT LOSS SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-251-4128
Mailing Address - Street 1:9707 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3348
Mailing Address - Country:US
Mailing Address - Phone:301-251-4128
Mailing Address - Fax:301-738-1593
Practice Address - Street 1:9707 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3348
Practice Address - Country:US
Practice Address - Phone:301-251-4128
Practice Address - Fax:301-738-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043330208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty