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General NPI Number Information
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NPI Number | 1174279228
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Entity Type | Organization
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Legal Business Name | ISLAMIC CENTER OF MARYLAND
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 19411 WOODFIELD RD
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City | GAITHERSBURG
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State | MD
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Zip | 20879-4726
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Country | US
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Telephone | 240-477-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 19411 WOODFIELD RD
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City | GAITHERSBURG
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State | MD
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Zip | 20879-4726
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Country | US
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Telephone | 301-375-0521
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | NURUDEEN THOMAS
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Credential |
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Telephone | 301-375-0521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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