| Legacy Physiatry Group | |
|
9711 Washingtonian Blvd Ste 550 Gaithersburg MD 20878-5789 | |
| (972) 881-4688 | |
| (972) 372-1657 |
| Full Name | Legacy Physiatry Group |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 04/23/2015 |
| Last Update Date | 10/27/2023 |
| Medicare PECOS PAC ID | 1355652108 |
|---|---|
| Medicare Enrollment ID | O20150619000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669869939 | NPI | - | NPPES |
| Provider Name | Angela L Street |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740485085 PECOS PAC ID: 5698759967 Enrollment ID: I20040615000645 |
| Provider Name | Deborah Reiss Schneider |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1245267806 PECOS PAC ID: 0648288373 Enrollment ID: I20060322000471 |
| Provider Name | Kelvinda Kamara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851641955 PECOS PAC ID: 6002050481 Enrollment ID: I20130925000575 |
| Provider Name | Jeffrey Banker |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1861497802 PECOS PAC ID: 6901994987 Enrollment ID: I20131113001302 |
| Provider Name | Edna Baffoe-bonnie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982117388 PECOS PAC ID: 8224399241 Enrollment ID: I20180307001419 |
| Provider Name | Frances Onyewu |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1184917551 PECOS PAC ID: 7810261856 Enrollment ID: I20180413001187 |
| Provider Name | Bruce Maxwell Neckritz |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1588669360 PECOS PAC ID: 6305897703 Enrollment ID: I20200929001704 |
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