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General NPI Number Information
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NPI Number | 1245502012
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Entity Type | Organization
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Legal Business Name | MY FAMILY MEDICAL CARE CENTER, LLC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 14201 LAUREL PARK DR SUITE 102A
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City | LAUREL
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State | MD
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Zip | 20707-5203
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Country | US
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Telephone | 301-490-6341
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Fax | 301-490-6343
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Provider Business Mailing Address
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Address Line | 14201 LAUREL PARK DR SUITE 102A
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City | LAUREL
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State | MD
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Zip | 20707-5203
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Country | US
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Telephone | 301-490-6341
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Fax | 301-490-6343
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY OMENONYE EHIABOR
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Credential | M.D.
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Telephone | 832-262-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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