Provider Demographics
NPI:1154618023
Name:MARYLAND INJURY CENTER, LLC
Entity type:Organization
Organization Name:MARYLAND INJURY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-853-1516
Mailing Address - Street 1:3321 TOLEDO TER
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4150
Mailing Address - Country:US
Mailing Address - Phone:301-853-1516
Mailing Address - Fax:301-853-1517
Practice Address - Street 1:3321 TOLEDO TER
Practice Address - Street 2:SUITE 204
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4150
Practice Address - Country:US
Practice Address - Phone:301-853-1516
Practice Address - Fax:301-853-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03591261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy