MEDICARE: LIFETOUCH CLINICAL CONSULTANTS,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	RN1009165	DC
2	261QP2300X	Primary Care Clinic/Center	R174293	MD

General Provider Information

NPI Number	:	1417492141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETOUCH CLINICAL CONSULTANTS,LLC

Provider Business Mailing Address
First Line	:	4512 DOCTOR BEANS LEGACY CIR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6384
Country	:	US
Telephone Number	:	202-257-2130
Fax Number	:

Provider Business Practice Location Address
First Line	:	4512 DOCTOR BEANS LEGACY CIR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6384
Country	:	US
Telephone Number	:	202-257-2130
Fax Number	:

Authorized Official
Title or Position	:	FNP-BC
Name	:	ESABELLA MAH TEBID MBAH
Credential	:	NP
Telephone Number	:	202-257-2130

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/23/2017

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