Provider Demographics
NPI:1780171579
Name:MARYLAND INJURY CLINICS
Entity type:Organization
Organization Name:MARYLAND INJURY CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JHERSON
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:OROSCO MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-869-9001
Mailing Address - Street 1:4 PARK AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2893
Mailing Address - Country:US
Mailing Address - Phone:301-869-9001
Mailing Address - Fax:
Practice Address - Street 1:4 PARK AVE STE 250
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2893
Practice Address - Country:US
Practice Address - Phone:301-869-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation