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General NPI Number Information
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NPI Number | 1619368206
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Entity Type | Organization
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Legal Business Name | OLDE TOWNE URGENT CARE, LLC
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 317 E DIAMOND AVE STE C
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City | GAITHERSBURG
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State | MD
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Zip | 20877-5327
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Country | US
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Telephone | 301-299-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 8404 TUCKERMAN LN
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City | POTOMAC
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State | MD
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Zip | 20854-3156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RASHA BAFI SALEEM
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Credential | MD
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Telephone | 301-299-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | D0059605
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License Number State | MD
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