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General NPI Number Information
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NPI Number | 1548069503
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MWLM LLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 7501 GREENWAY CENTER DR STE 660
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City | GREENBELT
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State | MD
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Zip | 20770-6700
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Country | US
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Telephone | 443-512-8337
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Fax | 443-327-5282
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Provider Business Mailing Address
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Address Line | 100 WALTER WARD BLVD STE 200
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City | ABINGDON
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State | MD
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Zip | 21009-1285
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Country | US
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Telephone | 443-512-8337
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Fax | 443-327-5282
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Authorized Official
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Title or Position | CEO
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Name | BRYAN MORROW
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Credential |
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Telephone | 443-512-8337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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