Provider Demographics
NPI:1871514067
Name:GREENBELT UROLOGY INSTITUTE, L.L.C.
Entity type:Organization
Organization Name:GREENBELT UROLOGY INSTITUTE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-477-2905
Mailing Address - Street 1:6502 KENILWORTH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1371
Mailing Address - Country:US
Mailing Address - Phone:301-461-6439
Mailing Address - Fax:301-477-2981
Practice Address - Street 1:6502 KENILWORTH AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1371
Practice Address - Country:US
Practice Address - Phone:301-461-6439
Practice Address - Fax:301-477-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty