Legacy Physiatry Group | |
9711 Washingtonian Blvd Ste 550 Gaithersburg MD 20878-5789 | |
(972) 881-4688 | |
(972) 372-1657 |
Full Name | Legacy Physiatry Group |
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Speciality | Physical Medicine & Rehabilitation |
Location | 9711 Washingtonian Blvd Ste 550, Gaithersburg, Maryland |
Authorized Official Name and Position | Marilyn J Mearon (BILLING MANAGER) |
Authorized Official Contact | 9728814688 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Legacy Physiatry Group 850 Central Pkwy E Ste 275 Plano TX 75074-5542 Ph: (972) 881-4688 | Legacy Physiatry Group 9711 Washingtonian Blvd Ste 550 Gaithersburg MD 20878-5789 Ph: (972) 881-4688 |
NPI Number | 1669869939 |
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Provider Enumeration Date | 04/23/2015 |
Last Update Date | 10/27/2023 |
Medicare PECOS PAC ID | 1355652108 |
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Medicare Enrollment ID | O20150619000722 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669869939 | NPI | - | NPPES |
Provider Name | Angela L Street |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740485085 PECOS PAC ID: 5698759967 Enrollment ID: I20040615000645 |
Provider Name | Deborah Reiss Schneider |
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Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1245267806 PECOS PAC ID: 0648288373 Enrollment ID: I20060322000471 |
Provider Name | Kelvinda Kamara |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851641955 PECOS PAC ID: 6002050481 Enrollment ID: I20130925000575 |
Provider Name | Jeffrey Banker |
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Provider Type | Practitioner - Cardiac Electrophysiology |
Provider Identifiers | NPI Number: 1861497802 PECOS PAC ID: 6901994987 Enrollment ID: I20131113001302 |
Provider Name | Edna Baffoe-bonnie |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982117388 PECOS PAC ID: 8224399241 Enrollment ID: I20180307001419 |
Provider Name | Frances Onyewu |
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Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1184917551 PECOS PAC ID: 7810261856 Enrollment ID: I20180413001187 |
Provider Name | Bruce Maxwell Neckritz |
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Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1588669360 PECOS PAC ID: 6305897703 Enrollment ID: I20200929001704 |
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