Basic Information
| Provider Information | |||||||||
| NPI: | 1699752840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METROPOLITAN GASTROENTEROLOGY GROUP | ||||||||
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| OtherOrganizationName: | MGG | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5550 FRIENDSHIP BLVD | ||||||||
| Address2: | SUITE T-90 | ||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208157256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016542521 | ||||||||
| FaxNumber: | 3019079423 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 K ST NW | ||||||||
| Address2: | SUITE T-110 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200061003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022963449 | ||||||||
| FaxNumber: | 2022969122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 3016542521 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.