MEDICARE: FIRST RESPONSE DOCTORS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse
2	363L00000X	Nurse Practitioner
3	363LA2100X	Acute Care Nurse Practitioner
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1861242067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST RESPONSE DOCTORS CLINIC

Provider Business Mailing Address
First Line	:	3214 BIRCHMEDE DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2302
Country	:	US
Telephone Number	:	240-604-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	11303 AMHERST AVE STE 2
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4600
Country	:	US
Telephone Number	:	240-604-2949
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER, BC-NP
Name	:	DR. LUM MERCY MAXIMUANGU
Credential	:	BC-NP
Telephone Number	:	240-604-2949

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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