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General NPI Number Information
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NPI Number | 1477269447
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Entity Type | Organization
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Legal Business Name | ICON MEDICINE
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 7411 RIGGS RD STE 300B
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City | HYATTSVILLE
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State | MD
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Zip | 20783-4246
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Country | US
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Telephone | 240-966-4266
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Fax | 301-235-1771
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Provider Business Mailing Address
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Address Line | 10770 COLUMBIA PIKE STE 300-1021
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City | SILVER SPRING
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State | MD
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Zip | 20901-4402
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Country | US
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Telephone | 240-966-4266
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Fax | 301-235-1771
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. TIMOTHY NYAKANGO ONSERIO
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Credential | DNP,APRN,FNP,CRNP
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Telephone | 240-966-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 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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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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