Provider Demographics
NPI:1952305740
Name:HEINZ-MOMCILOVIC, LIBUSE (MD)
Entity Type:Individual
Prefix:DR
First Name:LIBUSE
Middle Name:
Last Name:HEINZ-MOMCILOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10605 CONCORD ST
Mailing Address - Street 2:STE. 500
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2504
Mailing Address - Country:US
Mailing Address - Phone:301-942-2977
Mailing Address - Fax:301-942-8031
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:STE 213
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-942-2977
Practice Address - Fax:301-942-8031
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0058542207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH60512Medicare UPIN