Healthcare Provider Details

I. General information

NPI: 1932822954
Provider Name (Legal Business Name): AVALON HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARROLL ST STE 106
LA PLATA MD
20646-5987
US

IV. Provider business mailing address

401 CARROLL ST STE 106
LA PLATA MD
20646-5987
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-5552
  • Fax: 301-968-1231
Mailing address:
  • Phone: 888-360-5552
  • Fax: 301-968-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WANDA HART
Title or Position: OFFICER
Credential:
Phone: 888-360-5552