Provider Demographics
NPI:1356612279
Name:METRO IPC SILVER SPRING, LLC
Entity type:Organization
Organization Name:METRO IPC SILVER SPRING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-641-4155
Mailing Address - Street 1:8484 GEORGIA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5604
Mailing Address - Country:US
Mailing Address - Phone:202-641-4155
Mailing Address - Fax:301-263-7761
Practice Address - Street 1:8484 GEORGIA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5604
Practice Address - Country:US
Practice Address - Phone:202-641-4155
Practice Address - Fax:301-263-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD20115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD126211400Medicaid