| Poolesville Family Practice Llc | |
|
19710 Fisher Ave Suite J Poolesville MD 20837-0108 | |
| (301) 972-7600 | |
| (301) 972-8006 |
| Full Name | Poolesville Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 19710 Fisher Ave, Poolesville, Maryland |
| Authorized Official Name and Position | Amar Venkat Duggirala (FAMILY PHYSICIAN) |
| Authorized Official Contact | 3019727600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Poolesville Family Practice Llc 19710 Fisher Ave Suite J, Po Box 108 Poolesville MD 20837-2098 Ph: (301) 972-7600 | Poolesville Family Practice Llc 19710 Fisher Ave Suite J Poolesville MD 20837-0108 Ph: (301) 972-7600 |
| NPI Number | 1790953065 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 02/20/2008 |
| Medicare PECOS PAC ID | 3072689405 |
|---|---|
| Medicare Enrollment ID | O20080917000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790953065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H61505 (Maryland) | Primary |
| Provider Name | Amar V Duggirala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588672190 PECOS PAC ID: 8921046699 Enrollment ID: I20070124000644 |
| Provider Name | Katherine Hollingsworth Kirksey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457672206 PECOS PAC ID: 3577706472 Enrollment ID: I20180516000118 |
Poolesville Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19710 Fisher Ave, Suite J, Poolesville, MD 20837 Phone: 301-972-7600 |