Healthcare Provider Details

I. General information

NPI: 1245502012
Provider Name (Legal Business Name): MY FAMILY MEDICAL CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 LAUREL PARK DR SUITE 102A
LAUREL MD
20707-5203
US

IV. Provider business mailing address

14201 LAUREL PARK DR SUITE 102A
LAUREL MD
20707-5203
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-6341
  • Fax: 301-490-6343
Mailing address:
  • Phone: 301-490-6341
  • Fax: 301-490-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY OMENONYE EHIABOR
Title or Position: OWNER
Credential: M.D.
Phone: 832-262-7028