=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184866170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOAN P MEDWAY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2009
-----------------------------------------------------
Last Update Date | 04/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10008 COLEBROOK AVENUE
-----------------------------------------------------
City | POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20854-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-279-2667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10008 COLEBROOK AVENUE
-----------------------------------------------------
City | POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20854-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-279-2667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOAN P MEDWAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-279-2667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | #2521 LCSW-C
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------