Provider Demographics
NPI:1366517013
Name:GREATER WASHINGTON MEDICENTER LLC. T/A HEALTHCARE OF GREATER WASHINGTO
Entity type:Organization
Organization Name:GREATER WASHINGTON MEDICENTER LLC. T/A HEALTHCARE OF GREATER WASHINGTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-839-2700
Mailing Address - Street 1:6357 OXON HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2214
Mailing Address - Country:US
Mailing Address - Phone:301-358-0002
Mailing Address - Fax:301-839-1354
Practice Address - Street 1:6357 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2214
Practice Address - Country:US
Practice Address - Phone:301-839-2820
Practice Address - Fax:301-839-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00433Medicare PIN