Healthcare Provider Details

I. General information

NPI: 1154039162
Provider Name (Legal Business Name): MORAYO MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 ANNAPOLIS RD STE 324
GLENN DALE MD
20769-9184
US

IV. Provider business mailing address

2702 SWANN WING CT
GLENARDEN MD
20706-1683
US

V. Phone/Fax

Practice location:
  • Phone: 301-291-7077
  • Fax: 301-291-7073
Mailing address:
  • Phone: 202-674-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PATRICIA OSHODI
Title or Position: CEO
Credential: MD
Phone: 202-674-2576