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General NPI Number Information
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NPI Number | 1720101819
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Entity Type | Organization
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Legal Business Name | PHYSICIANS FAMILY PRACTICE, CHTRD.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 115 CENTERWAY
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City | GREENBELT
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State | MD
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Zip | 20770-1836
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Country | US
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Telephone | 301-474-2141
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Fax | 301-345-3874
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Provider Business Mailing Address
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Address Line | 115 CENTERWAY
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City | GREENBELT
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State | MD
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Zip | 20770-1836
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Country | US
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Telephone | 301-474-2141
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Fax | 301-345-3874
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID SAMUEL GRANITE
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Credential | MD, FAAFP, CGM
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Telephone | 301-474-2141
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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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