Healthcare Provider Details

I. General information

NPI: 1629470547
Provider Name (Legal Business Name): HEFUNA MENTAL HEALTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 FREDERICK RD SUITE 310
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

16220 FREDERICK RD SUITE 310
GAITHERSBURG MD
20877-4039
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax: 301-560-5557
Mailing address:
  • Phone: 301-345-1022
  • Fax: 301-560-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD66576
License Number StateMD

VIII. Authorized Official

Name: DR. AHMED HEFUNA
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 301-345-1022