Provider Demographics
NPI:1366785446
Name:ROCKVILLE GASTROENTEROLOGY AND HEPATOLOGY
Entity type:Organization
Organization Name:ROCKVILLE GASTROENTEROLOGY AND HEPATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIANMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-722-0707
Mailing Address - Street 1:8761 PRESTON PL
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5738
Mailing Address - Country:US
Mailing Address - Phone:507-722-0707
Mailing Address - Fax:301-552-2697
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:507-722-0707
Practice Address - Fax:301-552-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73853207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty