Provider Demographics
NPI:1780912022
Name:ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND LLC
Entity type:Organization
Organization Name:ENDOCRINOLOGY ASSOCIATES OF SOUTHERN MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-7445
Mailing Address - Street 1:7700 OLD BRANCH AVE
Mailing Address - Street 2:SUITE #B204
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1628
Mailing Address - Country:US
Mailing Address - Phone:301-856-7445
Mailing Address - Fax:240-244-1277
Practice Address - Street 1:10403 HOSPITAL DRIVE
Practice Address - Street 2:SUITE #G-07
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-856-7445
Practice Address - Fax:240-244-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060652207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT142431Medicare UPIN