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7610 Carroll Ave Suite 420 Takoma Park MD 20912-6384 | |
| (301) 891-5488 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 7610 Carroll Ave, Takoma Park, Maryland |
| Authorized Official Name and Position | James G Lee (CFO) |
| Authorized Official Contact | 3013153030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
820 W Diamond Ave Suite 500 Gaithersburg MD 20878-1419 Ph: (301) 315-3102 | 7610 Carroll Ave Suite 420 Takoma Park MD 20912-6384 Ph: (301) 891-5488 |
| NPI Number | 1073055950 |
|---|---|
| Provider Enumeration Date | 11/09/2016 |
| Last Update Date | 11/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073055950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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