Healthcare Provider Details

I. General information

NPI: 1861849051
Provider Name (Legal Business Name): YOUR TIME MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10339 SOUTHERN MARYLAND BLVD STE 206
DUNKIRK MD
20754-3018
US

IV. Provider business mailing address

3307 FERRY LANDING RD
DUNKIRK MD
20754-9647
US

V. Phone/Fax

Practice location:
  • Phone: 443-646-3532
  • Fax: 404-480-3984
Mailing address:
  • Phone: 718-791-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0078131
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: IMMIRNE MONET OUWINGA
Title or Position: PHYSICIAN
Credential: MD
Phone: 718-791-2223