Basic Information
| Provider Information | |||||||||
| NPI: | 1770135261 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERDYNAMICS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8181 PROFESSIONAL PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207857219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013064590 | ||||||||
| FaxNumber: | 3018800054 | ||||||||
| Practice Location | |||||||||
| Address1: | 8181 PROFESSIONAL PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207857219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013064590 | ||||||||
| FaxNumber: | 3018800054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | BRANCH | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3013064590 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.