Provider Demographics
NPI:1467020859
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EHR PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:MARTINE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-777-1643
Mailing Address - Street 1:19401 CRYSTAL ROCK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1593
Mailing Address - Country:US
Mailing Address - Phone:240-740-6402
Mailing Address - Fax:
Practice Address - Street 1:19401 CRYSTAL ROCK DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1593
Practice Address - Country:US
Practice Address - Phone:240-740-6402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD123456789Medicaid