MEDICARE: MCLAREN MEDICAL CENTER PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101236776	VA

General Provider Information

NPI Number	:	1871991729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLAREN MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	5140 PORT TOBACCO RD
Second Line	:
City	:	NANJEMOY
State	:	MD
Zip	:	20662-3317
Country	:	US
Telephone Number	:	240-417-6424
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 FOREST DR
Second Line	:	STE B
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1005
Country	:	US
Telephone Number	:	240-417-6424
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABDULKAREEM I KRAIDY
Credential	:	M.D.
Telephone Number	:	240-417-6424

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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Directions to “MCLAREN MEDICAL CENTER PC ” Practice Location

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