MEDICARE: EXPRESS HEALTHCARE, 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1942664743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	7582 ANNAPOLIS RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1744
Country	:	US
Telephone Number	:	301-577-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	7582 ANNAPOLIS RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1744
Country	:	US
Telephone Number	:	301-577-6665
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMAL FADUL
Credential	:	M.D.
Telephone Number	:	301-577-6665

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/20/2016

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Directions to “EXPRESS HEALTHCARE, LLC ” Practice Location

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