NPIMap

Organization Active NPI

Ennoble HC DMV LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Fulton, MD
National Provider Identifier
1104492115
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
ENNOBLE HC DMV LLC
Practice address
8115 Maple Lawn Blvd Ste 350
Fulton, MD 20759-2683
Phone
(862) 812-9010
NPI assigned
Jun 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Authorized official

Name
Kush Das
Title
Manager
Phone
(201) 956-8233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

8115 Maple Lawn Blvd Ste 350
Fulton, MD 20759-2683

Mailing address

39 V St NE
Washington, DC 20002-1329
Phone (862) 812-9010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, GA, MD, VA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20211007000017 DC Part B Supplier - Clinic/Group Practice 9032517925 Receives reassigned benefits from 88 practitioners
Practice locations: Fairfax, VA; Silver Spring, MD; Washington, DC
O20211029000202 GA Part B Supplier - Clinic/Group Practice 9032517925 Receives reassigned benefits from 66 practitioners
Practice locations: Atlanta, GA
O20211209000400 MD Part B Supplier - Clinic/Group Practice 9032517925 Receives reassigned benefits from 53 practitioners
Practice locations: Fulton, MD
O20211221000236 VA Part B Supplier - Clinic/Group Practice 9032517925 Receives reassigned benefits from 52 practitioners
Practice locations: Ashburn, VA

National Provider Directory

National Provider Directory

Locations

2002 Summit Blvd
Brookhaven, GA 30319
Phone (404) 882-8822

50 Glenlake Pkwy
Sandy Springs, GA 30328
Phone (678) 328-4100

50 Glenlake Pkwy
Ste 800
Sandy Springs, GA 30328

8101 Sandy Spring Rd
Ste 300W28
Laurel, MD 20707

962 Wayne Ave
Silver Spring, MD 20910
Phone (240) 744-0001

Practitioners & affiliated clinicians

Practitioners 162

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 162

NPI Registry JSON

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1104492115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 V ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200021329",
            "telephone_number": "862-812-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8115 MAPLE LAWN BLVD STE 350",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592683",
            "telephone_number": "862-812-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENNOBLE HC DMV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "DAS",
        "authorized_official_first_name": "KUSH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "201-956-8233"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.