| Fam | |
|
14201 Old Stage Rd Bowie MD 20720-4880 | |
| (301) 821-7716 | |
| Not Available |
| Full Name | Fam |
|---|---|
| Speciality | Social Worker |
| Location | 14201 Old Stage Rd, Bowie, Maryland |
| Authorized Official Name and Position | Kelvin L Mitchell (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 3018217716 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fam 11205 Westport Dr Bowie MD 20720-3411 Ph: (301) 821-7716 | Fam 14201 Old Stage Rd Bowie MD 20720-4880 Ph: (301) 821-7716 |
| NPI Number | 1811496474 |
|---|---|
| Provider Enumeration Date | 02/08/2018 |
| Last Update Date | 07/07/2020 |
| Certification Date | 07/07/2020 |
| Medicare PECOS PAC ID | 6800211319 |
|---|---|
| Medicare Enrollment ID | O20200730003583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811496474 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 15294 (Maryland) | Primary |
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