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General NPI Number Information
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NPI Number | 1629470547
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Entity Type | Organization
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Legal Business Name | HEFUNA MENTAL HEALTH WELLNESS LLC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 16220 FREDERICK RD SUITE 310
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4039
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Country | US
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Telephone | 301-345-1022
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Fax | 301-560-5557
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Provider Business Mailing Address
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Address Line | 16220 FREDERICK RD SUITE 310
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4039
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Country | US
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Telephone | 301-345-1022
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Fax | 301-560-5557
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. AHMED HEFUNA
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Credential | MD
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Telephone | 301-345-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D66576
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License Number State | MD
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