NPIMap

Organization Active NPI

Donald W. Wiczer, M.D., George M. Korengold, M.D., Vanessa M. Mayol

  • Pediatrics Physician
  • Potomac, MD
National Provider Identifier
1003927146
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0017886 Issued in MD
Legal business name
DONALD W. WICZER, M.D., GEORGE M. KORENGOLD, M.D., VANESSA M. MAYOL
Practice address
11325 Seven Locks Road
# 238
Potomac, MD 20854
Phone
(301) 299-8930
Fax
(301) 299-8933
NPI assigned
Aug 31, 2006
Last updated
Jul 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. George M. Korengold, M.D.NPI 1275530438
Title
President
Phone
(301) 299-8930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0017886 MD Primary

Addresses

Primary practice location

11325 Seven Locks Road
# 238
Potomac, MD 20854

Mailing address

11325 Seven Locks Road
# 238
Potomac, MD 20854
Phone (301) 299-8930

Other identifiers 3

IdentifierTypeStateIssuer
910821100MedicaidMD
S962OtherMDCAREFIRST OF MD
C043OtherDCCAREFIRST/BLUE CHOICE

Other names 1

  • Bethesda Pediatrics Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0213045Bethesda Pediatrics11325 Seven Locks Rd, Potomac, MD 20854ComplianceDec 26, 2027

National Provider Directory

National Provider Directory

Locations

11325 Seven Locks Rd
Ste 238
Potomac, MD 20854
Phone (301) 299-8930

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1003927146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11325 SEVEN LOCKS ROAD",
            "address_2": "# 238",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "20854",
            "telephone_number": "301-299-8930",
            "fax_number": "301-299-8933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 SEVEN LOCKS ROAD",
            "address_2": "# 238",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "20854",
            "telephone_number": "301-299-8930",
            "fax_number": "301-299-8933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONALD W. WICZER, M.D., GEORGE M. KORENGOLD, M.D., VANESSA M. MAYOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "KORENGOLD",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-299-8930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0017886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "910821100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST OF MD",
            "identifier": "S962",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST/BLUE CHOICE",
            "identifier": "C043",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethesda Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Potomac, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.