| Advanced General Practice, Llc | |
|
12501 Prosperity Dr Ste 330 Silver Spring MD 20904-1655 | |
| (301) 592-1780 | |
| (240) 645-4013 |
| Full Name | Advanced General Practice, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12501 Prosperity Dr Ste 330, Silver Spring, Maryland |
| Authorized Official Name and Position | Isis M Diaz (OFFICE MANAGER) |
| Authorized Official Contact | 3015921780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced General Practice, Llc 10801 Lockwood Dr Ste 140 Silver Spring MD 20901-1559 Ph: (301) 592-1780 | Advanced General Practice, Llc 12501 Prosperity Dr Ste 330 Silver Spring MD 20904-1655 Ph: (301) 592-1780 |
| NPI Number | 1386131118 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 03/31/2021 |
| Medicare PECOS PAC ID | 6204190069 |
|---|---|
| Medicare Enrollment ID | O20180502000459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386131118 | NPI | - | NPPES |
| 446936400 | Medicaid | MD | |
| 280571YQNZ | Other | MD | MARYLAND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0074695 (Marshall Islands) | Primary |
| Provider Name | Lendicita Q Madden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407066723 PECOS PAC ID: 7618124819 Enrollment ID: I20120823000009 |
| Provider Name | Rebeccah W Depp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972153849 PECOS PAC ID: 6901219633 Enrollment ID: I20210119001354 |
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