Provider Demographics
NPI:1356935019
Name:MARYLAND REGENERATIVE THERAPY
Entity type:Organization
Organization Name:MARYLAND REGENERATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ITAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMHON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-444-4890
Mailing Address - Street 1:50 W EDMONSTON DR STE 602
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1216
Mailing Address - Country:US
Mailing Address - Phone:301-444-4890
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 602
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1216
Practice Address - Country:US
Practice Address - Phone:301-444-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty