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General NPI Number Information
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NPI Number | 1639961899
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Entity Type | Organization
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Legal Business Name | GOLDSTAR FAMILY PRACTICE
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 7404 EXECUTIVE PL STE 100
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City | LANHAM
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State | MD
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Zip | 20706-6237
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Country | US
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Telephone | 301-792-3797
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Fax |
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Provider Business Mailing Address
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Address Line | 14408 BURSLEM TER
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City | BURTONSVILLE
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State | MD
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Zip | 20866-2014
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Country | US
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Telephone | 301-792-3797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA NGWISAH BOLIMA
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Credential | FNP
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Telephone | 301-792-3798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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