| Affiliated Sante Group | |
|
1400 Spring St Ste 100 Silver Spring MD 20910-2751 | |
| (301) 589-2303 | |
| (301) 585-2965 |
| Full Name | Affiliated Sante Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 1400 Spring St Ste 100, Silver Spring, Maryland |
| Authorized Official Name and Position | Steven Sahm (BILLING MANAGER) |
| Authorized Official Contact | 3015726585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affiliated Sante Group 12200 Tech Rd Ste 330 Silver Spring MD 20904-1913 Ph: (301) 572-6585 | Affiliated Sante Group 1400 Spring St Ste 100 Silver Spring MD 20910-2751 Ph: (301) 589-2303 |
| NPI Number | 1083720569 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 09/16/2019 |
| Medicare PECOS PAC ID | 4385546639 |
|---|---|
| Medicare Enrollment ID | O20040402000456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083720569 | NPI | - | NPPES |
| 352850200 | Medicaid | MD | |
| 340671700 | Medicaid | MD | |
| 3406717000 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dwight L Donesky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194809640 PECOS PAC ID: 5092752766 Enrollment ID: I20140221000733 |
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