Provider Demographics
NPI:1235609330
Name:METRO MEN'S HEALTH MARYLAND, LLC
Entity type:Organization
Organization Name:METRO MEN'S HEALTH MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-710-6510
Mailing Address - Street 1:11300 ROCKVILLE PIKE STE 406
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3083
Mailing Address - Country:US
Mailing Address - Phone:301-710-6510
Mailing Address - Fax:
Practice Address - Street 1:11300 ROCKVILLE PIKE STE 406
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3083
Practice Address - Country:US
Practice Address - Phone:301-710-6510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center