Healthcare Provider Details

I. General information

NPI: 1346595824
Provider Name (Legal Business Name): WOMEN KIDS & TEENS AFTERHOURS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE SUITE 210
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

10313 GEORGIA AVE SUITE 210
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-592-0050
  • Fax: 301-592-8005
Mailing address:
  • Phone: 301-592-0050
  • Fax: 301-592-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: NGOZI R AGWUNA
Title or Position: MEMBER
Credential: M.D
Phone: 301-592-0050