Provider Demographics
NPI:1356396667
Name:SECURE MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:SECURE MEDICAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-869-0700
Mailing Address - Street 1:803 RUSSELL AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3584
Mailing Address - Country:US
Mailing Address - Phone:301-869-0700
Mailing Address - Fax:301-947-9513
Practice Address - Street 1:803 RUSSELL AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3584
Practice Address - Country:US
Practice Address - Phone:301-869-0700
Practice Address - Fax:301-947-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00179Medicare ID - Type Unspecified