Healthcare Provider Details

I. General information

NPI: 1790473593
Provider Name (Legal Business Name): VIRTUAL ACCESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 12/12/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 545
LAUREL MD
20708-3287
US

IV. Provider business mailing address

14502 GREENVIEW DR STE 545
LAUREL MD
20708-3287
US

V. Phone/Fax

Practice location:
  • Phone: 240-473-3007
  • Fax: 949-695-2194
Mailing address:
  • Phone: 240-473-3007
  • Fax: 949-695-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AMELIA Y ABBAN
Title or Position: OWNER
Credential: CRNP
Phone: 240-533-1182