Healthcare Provider Details

I. General information

NPI: 1699149013
Provider Name (Legal Business Name): GREENWAY FAMILY MEDICAL PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GREENWAY CENTER DR 105
GREENBELT MD
20770-3509
US

IV. Provider business mailing address

7525 GREENWAY CENTER DR 105
GREENBELT MD
20770-3509
US

V. Phone/Fax

Practice location:
  • Phone: 301-313-0425
  • Fax: 301-313-0435
Mailing address:
  • Phone: 301-313-0425
  • Fax: 301-313-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: MARIAM ASHIQ
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-313-0425