Provider Demographics
NPI:1770158206
Name:METRO GERONTOLOGY CENTER LLC
Entity type:Organization
Organization Name:METRO GERONTOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIHO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-206-1650
Mailing Address - Street 1:16051 COMPRINT CIR STE 68
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1320
Mailing Address - Country:US
Mailing Address - Phone:571-206-1650
Mailing Address - Fax:703-662-6165
Practice Address - Street 1:16051 COMPRINT CIR STE 68
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1320
Practice Address - Country:US
Practice Address - Phone:571-206-1650
Practice Address - Fax:703-662-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty