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General NPI Number Information
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NPI Number | 1376180596
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Entity Type | Organization
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Legal Business Name | MD MEDICAL AND WELLNESS CENTER
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 4000 MITCHELLVILLE RD STE A308
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City | BOWIE
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State | MD
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Zip | 20716-3135
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Country | US
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Telephone | 301-808-0341
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Fax | 301-263-6860
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Provider Business Mailing Address
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Address Line | 4000 MITCHELLVILLE RD STE A308
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City | BOWIE
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State | MD
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Zip | 20716-3135
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Country | US
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Telephone | 301-808-0341
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Fax | 301-263-6860
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MIRIAM D. MARTIN
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Credential | MD
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Telephone | 301-808-0341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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