Provider Demographics
NPI:1679342554
Name:ACKERLY MCBRIDE GROUP PLLC
Entity type:Organization
Organization Name:ACKERLY MCBRIDE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STADNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-953-0990
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW STE 215
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4368
Mailing Address - Country:US
Mailing Address - Phone:202-953-0990
Mailing Address - Fax:202-845-7344
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW STE 215
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4368
Practice Address - Country:US
Practice Address - Phone:202-953-0990
Practice Address - Fax:202-845-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty