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General NPI Number Information
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NPI Number | 1811715154
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Entity Type | Organization
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Legal Business Name | PATIENTWELL CONNECT
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 6800 WISCONSIN AVE # 1023
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City | CHEVY CHASE
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State | MD
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Zip | 20815-6105
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Country | US
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Telephone | 301-973-3257
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Fax | 301-220-6529
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Provider Business Mailing Address
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Address Line | 6800 WISCONSIN AVE # 1023
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City | CHEVY CHASE
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State | MD
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Zip | 20815-6105
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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 | CREDENTIALER
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Name | MASHKOUR RUB
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Credential |
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Telephone | 301-973-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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