Premier Rehabilitation Medicine Associates LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

D0066461 Issued in MD

Legal business name

PREMIER REHABILITATION MEDICINE ASSOCIATES LLC

Practice address

12505 Dorsey LN
Upper Marlboro, MD 20772-5374

Phone

(410) 499-8092

Fax

(301) 868-4446

NPI assigned

Aug 12, 2013

Organization subpart

No

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

Authorized official

Name

Kisha Perkins Brown, MD

Title

Owner

Phone

(410) 499-8092

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376265600000",
    "number": "1497188601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12505 DORSEY LN",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207725374",
            "telephone_number": "410-499-8092",
            "fax_number": "301-868-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12505 DORSEY LN",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207725374",
            "telephone_number": "410-499-8092",
            "fax_number": "301-868-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER REHABILITATION MEDICINE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KISHA",
        "authorized_official_middle_name": "PERKINS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-499-8092",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "D0066461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.