Active NPI
Olney Medical Group, LLC
- Internal Medicine Physician
- Olney, MD
National Provider Identifier
1720019011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- D43430
- Legal business name
- OLNEY MEDICAL GROUP, LLC
- Practice address
- 3411 Olandwood CT
Suite 105
Olney, MD 20832-1488 - Phone
- (301) 774-5260
- Fax
- (301) 774-1336
- NPI assigned
- Jul 5, 2006
- Last updated
- Jun 30, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gaurang Thaker, MD
- Title
- Owner
- Phone
- (301) 774-5260
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D43430 | MD | Primary |
Addresses
Primary practice location
3411 Olandwood CT
Suite 105
Olney, MD 20832-1488
Mailing address
PO Box 157
Ashton, MD 20861-0157
Phone (301) 570-9700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 488302100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
11125 Rockville Pike
Ste 208
Rockville, MD 20852
Phone (240) 750-9966
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": "1152057600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1277856000000",
"number": "1720019011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 157",
"city": "ASHTON",
"state": "MD",
"postal_code": "208610157",
"telephone_number": "301-570-9700",
"fax_number": "301-260-2838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3411 OLANDWOOD CT",
"address_2": "SUITE 105",
"city": "OLNEY",
"state": "MD",
"postal_code": "208321488",
"telephone_number": "301-774-5260",
"fax_number": "301-774-1336"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OLNEY MEDICAL GROUP, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-05",
"last_updated": "2010-06-30",
"status": "A",
"authorized_official_last_name": "THAKER",
"authorized_official_first_name": "GAURANG",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "301-774-5260",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MD",
"license": "D43430",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "488302100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olney, MD
- Olney Counseling Center LLC
- Olney Emdr LLC (Lisa Garcia, MSW, LCSW-C)
- Olney Endoscopy Center
- Olney Family Hearing LLC
- Olney Medical Associates
- Olney Modern Dentistry, LLC (Olney Modern Dentistry)
- Olney Open MRI LLC (Progressive Radiology)
- Olney Optical Med, LLC (My eye Dr)
- Olney Opticians,Inc.
- Olney Pain Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.