Healthcare Provider Details

I. General information

NPI: 1649550930
Provider Name (Legal Business Name): ADVANCED WALK IN URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR SUITE 140
SILVER SPRING MD
20901-1556
US

IV. Provider business mailing address

10801 LOCKWOOD DR SUITE 140
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-860-0888
  • Fax: 301-860-0889
Mailing address:
  • Phone: 301-860-0888
  • Fax: 301-860-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0047838
License Number StateMD

VIII. Authorized Official

Name: DR. NAOMI IHEDIOHA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 301-860-0888