Deer Park Internal Medicine

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

D0060871 Issued in MD

Legal business name

DEER PARK INTERNAL MEDICINE

Practice address

600 S Frederick Ave
Suite 302
Gaithersburg, MD 20877-1245

Phone

(301) 208-1188

Fax

(301) 208-1178

NPI assigned

Oct 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michelle Hong Tan, MD, PHD

Title

Physician

Phone

(301) 208-1188

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1720277379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S FREDERICK AVE",
            "address_2": "SUITE 302",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771245",
            "telephone_number": "301-208-1188",
            "fax_number": "301-208-1178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S FREDERICK AVE",
            "address_2": "SUITE 302",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771245",
            "telephone_number": "301-208-1188",
            "fax_number": "301-208-1178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER PARK INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "HONG",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "301-208-1188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MD",
            "license": "D0060871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Sadie-Lee Decker
• Victoria Decker, RN, DN
• Richard Jasper Deen
• Zainab Deen
• Deer Park Chiropractic P.C.
• Cara Depp Dehghan, PSY.D.
• Sherri Dela Cruz
• Patricia Elizabeth Deleon, R.N.
• Marie Brizard Delices, SOCIAL WORKER
• Samantha Dellosso, LMSW

• Medical Specialty Clinic/Center in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Medical Specialty Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.