| Family Medicine Shady Grove, Llc | |
|
15215 Shady Grove Rd Ste 304 Rockville MD 20850-0200 | |
| (301) 284-8990 | |
| (301) 569-4293 |
| Full Name | Family Medicine Shady Grove, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 15215 Shady Grove Rd Ste 304, Rockville, Maryland |
| Authorized Official Name and Position | Manisha Kalra (PHYSICIAN) |
| Authorized Official Contact | 3012848990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Shady Grove, Llc 15215 Shady Grove Rd Ste 304 Rockville MD 20850-0200 Ph: (301) 284-8990 | Family Medicine Shady Grove, Llc 15215 Shady Grove Rd Ste 304 Rockville MD 20850-0200 Ph: (301) 284-8990 |
| NPI Number | 1588093371 |
|---|---|
| Provider Enumeration Date | 11/02/2013 |
| Last Update Date | 04/21/2014 |
| Medicare PECOS PAC ID | 3375775612 |
|---|---|
| Medicare Enrollment ID | O20140501001029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588093371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D0073851 (Maryland) | Primary |
| Provider Name | Rohit Seem |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962480400 PECOS PAC ID: 8123022456 Enrollment ID: I20120829000376 |
| Provider Name | Manisha Kalra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942255468 PECOS PAC ID: 9335151018 Enrollment ID: I20120927000040 |
| Provider Name | Audrey Anne Gross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497221030 PECOS PAC ID: 8123365772 Enrollment ID: I20190122000059 |
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