Healthcare Provider Details
I. General information
NPI: 1427346899
Provider Name (Legal Business Name): COMPASSIONATE SPECIALTY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/19/2011
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7831 BELLE POINT DR
GREENBELT MD
20770-3338
US
IV. Provider business mailing address
10319 WESTLAKE DR STE 193
BETHESDA MD
20817-6403
US
V. Phone/Fax
- Phone: 301-902-0664
- Fax:
- Phone: 216-502-4311
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111NR0200X |
| Taxonomy | Radiology Chiropractor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111NR0400X |
| Taxonomy | Rehabilitation Chiropractor |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111NS0005X |
| Taxonomy | Sports Physician Chiropractor |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RH0002X |
| Taxonomy | Hospice and Palliative Medicine (Internal Medicine) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
IVAN
ZAMA
Title or Position: OWNER
Credential: M.D.,
Phone: 301-902-0664