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General NPI Number Information
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NPI Number | 1124531702
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Entity Type | Organization
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Legal Business Name | VILLAGE GREEN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1684 VILLAGE GRN LOWR LEVEL
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City | CROFTON
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State | MD
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Zip | 21114-2059
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Country | US
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Telephone | 410-721-3822
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Fax | 410-451-0960
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Provider Business Mailing Address
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Address Line | 1684 VILLAGE GRN LOWR LEVEL
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City | CROFTON
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State | MD
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Zip | 21114-2059
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Country | US
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Telephone | 410-721-3822
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Fax | 410-451-0960
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Authorized Official
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Title or Position | OWNER EMPLOYEE
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Name | ALLISON N WILLIAMS
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Credential | MD
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Telephone | 410-721-3822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0061041
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License Number State | MD
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