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Type 1 Individual Provider — NPI 1952543191, Silver Spring, MD | NPI Central

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NPI 1952543191

OrganizationActive

Type 1 Individual Provider

NPI 1952543191 · Exclusive Provider Organization · Silver Spring, MD

Provider details

NPI number: 1952543191
Entity type: Organization
Primary specialty: Exclusive Provider OrganizationManaged Care Organizations
Organization subpart: No
Authorized official: Brena Gibson, Human Resources Director(301) 439-7191
License: LC2381 (MD)

Specialties & taxonomies

Exclusive Provider OrganizationPrimary302F00000XLicense LC2381 (MD)
Managed Care Organizations

Practice location

1620 Elton Rd

Silver Spring, MD 20903-1740

Phone: (301) 439-7191

Approximate (ZIP-level) locationGet directions

More MD providers

Mailing address

1620 Elton Rd

Silver Spring, MD 20903-1740

Other names (DBA / former)

Other name: Type 1 Individual Provider

Registry dates

Enumerated: 2009-04-02
Last updated: 2009-04-08

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.