Healthcare Provider Details

I. General information

NPI: 1548069503
Provider Name (Legal Business Name): INNOVATIVE MWLM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 GREENWAY CENTER DR STE 660
GREENBELT MD
20770-6700
US

IV. Provider business mailing address

100 WALTER WARD BLVD STE 200
ABINGDON MD
21009-1285
US

V. Phone/Fax

Practice location:
  • Phone: 443-512-8337
  • Fax: 443-327-5282
Mailing address:
  • Phone: 443-512-8337
  • Fax: 443-327-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN MORROW
Title or Position: CEO
Credential:
Phone: 443-512-8337