Provider Demographics
NPI:1841898426
Name:TAKOMA PARK GYNECOLOGY LLC
Entity type:Organization
Organization Name:TAKOMA PARK GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:301-960-1155
Mailing Address - Street 1:7050 CARROLL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:301-960-1155
Mailing Address - Fax:301-690-0097
Practice Address - Street 1:7050 CARROLL
Practice Address - Street 2:SUITE 201
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-960-1155
Practice Address - Fax:301-690-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty