Healthcare Provider Details

I. General information

NPI: 1427865583
Provider Name (Legal Business Name): FOUNDATIONAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 DECKMAN LN
SILVER SPRING MD
20906-2262
US

IV. Provider business mailing address

2339 DECKMAN LN
SILVER SPRING MD
20906-2262
US

V. Phone/Fax

Practice location:
  • Phone: 503-891-2142
  • Fax: 240-744-7538
Mailing address:
  • Phone: 503-891-2142
  • Fax: 240-744-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVIS
Title or Position: CO-FOUNDER
Credential: ND
Phone: 971-231-4325