Healthcare Provider Details

I. General information

NPI: 1285196295
Provider Name (Legal Business Name): XPRESS MEDICAL SPECIALTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 ANNAPOLIS RD STE 225
GLENN DALE MD
20769-9182
US

IV. Provider business mailing address

12200 ANNAPOLIS RD STE 225
GLENN DALE MD
20769-9182
US

V. Phone/Fax

Practice location:
  • Phone: 301-390-6232
  • Fax: 301-390-6243
Mailing address:
  • Phone: 301-390-6232
  • Fax: 301-390-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA RICE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 301-390-6232