Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2016-08-29
- Last updated
- 2016-08-29
Specialties
Licenses
- License MD
- 01357L
Location
- Practice location
- 17340 QUAKER LN
- City
- SANDY SPRING MD
- Postal code
- 208601247
- Phone
- 301-924-5100
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.