Healthcare Provider Details

I. General information

NPI: 1568075737
Provider Name (Legal Business Name): MARYLAND PRIMARY CARE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HARRY S TRUMAN DR N STE 550
UPPER MARLBORO MD
20774-5485
US

IV. Provider business mailing address

7100 LONGWOOD DR
BETHESDA MD
20817-2120
US

V. Phone/Fax

Practice location:
  • Phone: 301-627-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALBERT TAKEM
Title or Position: OWNER
Credential:
Phone: 240-408-6286