Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-09-09
- Last updated
- 2026-09-09
Specialties
Licenses
- License MD
- 03416L
Location
- Practice location
- 800 S FREDERICK AVE STE 101
- City
- GAITHERSBURG MD
- Postal code
- 208774151
- Phone
- 347-944-7546
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.