Agas Medical Group, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

D0034747 Issued in MD

Legal business name

AGAS MEDICAL GROUP, LLC

Practice address

9811 Mallard Dr
Suite # 213
Laurel, MD 20708-3143

Phone

(301) 604-0562

Fax

(240) 840-9533

NPI assigned

Mar 19, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly A. Anderson, M. D.

Title

Physician

Phone

(301) 483-7999

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1134461940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9811 MALLARD DR",
            "address_2": "SUITE # 213",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083143",
            "telephone_number": "301-604-0562",
            "fax_number": "240-840-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9811 MALLARD DR",
            "address_2": "SUITE # 213",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083143",
            "telephone_number": "301-604-0562",
            "fax_number": "240-840-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAS MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-19",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "301-483-7999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MD",
            "license": "D0034747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010167200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.