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General NPI Number Information
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NPI Number | 1578035135
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Entity Type | Organization
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Legal Business Name | GWENDOLYN V YOUNGBLOOD, MD, PC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 7525 GREENWAY CENTER DR STE 311
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City | GREENBELT
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State | MD
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Zip | 20770-3525
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Country | US
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Telephone | 301-441-4555
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Fax | 301-441-3420
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Provider Business Mailing Address
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Address Line | 7525 GREENWAY CENTER DR STE 311
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City | GREENBELT
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State | MD
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Zip | 20770-3525
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Country | US
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Telephone | 301-441-4555
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Fax | 301-441-3420
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Authorized Official
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Title or Position | OWNER
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Name | GWENDOLYN VIRGINIA YOUNGBLOOD
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Credential | MD
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Telephone | 301-441-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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