MEDICARE: PRUDENT MEDICAL ASSOCIATES LLC

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	363LF0000X	Family Nurse Practitioner	RN1003033	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932541786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRUDENT MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	7100 BALTIMORE AVE STE 510
Second Line	:
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-3641
Country	:	US
Telephone Number	:	240-467-5739
Fax Number	:	240-467-5795

Provider Business Practice Location Address
First Line	:	7100 BALTIMORE AVE STE 510
Second Line	:
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-3641
Country	:	US
Telephone Number	:	240-467-5739
Fax Number	:	240-467-5795

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH I OKONOFUA
Credential	:	DNP
Telephone Number	:	301-254-8509

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	12/07/2018

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