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General NPI Number Information
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NPI Number | 1588469548
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Entity Type | Organization
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Legal Business Name | HEALTHDRIVE MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 6700 ALEXANDER BELL DR STE 200
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City | COLUMBIA
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State | MD
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Zip | 21046-2105
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Country | US
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Telephone | 888-964-6681
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Fax | 888-662-0859
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Provider Business Mailing Address
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Address Line | 100 CROSSING BLVD STE 300
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City | FRAMINGHAM
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State | MA
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Zip | 01702-5555
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Country | US
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Telephone | 857-255-0486
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Fax | 339-686-2561
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Authorized Official
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Title or Position | PRESIDENT
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Name | WASEEM GHANNAM
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Credential | MD
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Telephone | 704-231-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal 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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 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 #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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