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General NPI Number Information
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NPI Number | 1871874859
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Entity Type | Organization
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Legal Business Name | EZE FAMILY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 11750 BUSINESS PARK DR SUITE 103
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City | WALDORF
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State | MD
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Zip | 20601-2907
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Country | US
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Telephone | 301-323-3921
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Fax | 888-519-5179
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Provider Business Mailing Address
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Address Line | 11750 BUSINESS PARK DR SUITE 103
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City | WALDORF
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State | MD
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Zip | 20601-2907
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Country | US
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Telephone | 301-323-3921
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Fax | 888-519-5179
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Authorized Official
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Title or Position | MEDICAL PRACTITIONER / CEO
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Name | CHINYERE EZE
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Credential | PA-C
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Telephone | 301-323-3921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0004111
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | D0037088
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | D69441
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License Number State | MD
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