NPIMap

Organization Active NPI

Revitalize LLC

Doing business as Optimal Health Physicians

  • Internal Medicine Physician
  • Rockville, MD
National Provider Identifier
1417238015
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0050126 Issued in MD
Legal business name
REVITALIZE LLC
Doing business as
Optimal Health Physicians
Practice address
15235 Shady Grove Rd
Suite 102
Rockville, MD 20850-3234
Phone
(301) 330-9430
Fax
(301) 330-6515
NPI assigned
Sep 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

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

Authorized official

Name
Dr. Norton Fishman, MDNPI 1447305826
Title
Medical Director
Phone
(301) 330-9430

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X H67624 MD
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X D0050126 MD Primary

Addresses

Primary practice location

15235 Shady Grove Rd
Suite 102
Rockville, MD 20850-3234

Mailing address

15235 Shady Grove Rd
Suite 102
Rockville, MD 20850-3234
Phone (301) 330-9430

Other names 1

  • Optimal Health Physicians Doing business as

National Provider Directory

National Provider Directory

Locations

15235 Shady Grove Rd
Ste 102
Rockville, MD 20850
Phone (301) 330-9430

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319414400000",
    "number": "1417238015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15235 SHADY GROVE RD",
            "address_2": "SUITE 102",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503234",
            "telephone_number": "301-330-9430",
            "fax_number": "301-330-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15235 SHADY GROVE RD",
            "address_2": "SUITE 102",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503234",
            "telephone_number": "301-330-9430",
            "fax_number": "301-330-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-10-24",
        "status": "A",
        "authorized_official_last_name": "FISHMAN",
        "authorized_official_first_name": "NORTON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-330-9430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H67624",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0050126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Health Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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.