Elite Multi Specialty Clinic, Llc | |
12501 Prosperity Dr Ste 330 Silver Spring MD 20904-1655 | |
(301) 604-4033 | |
(240) 645-4013 |
Full Name | Elite Multi Specialty Clinic, Llc |
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Speciality | Clinic/Center |
Location | 12501 Prosperity Dr Ste 330, Silver Spring, Maryland |
Authorized Official Name and Position | Adaora Perpetua Noummy (PRESIDENT/OWNER) |
Authorized Official Contact | 3016044033 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Elite Multi Specialty Clinic, Llc 12501 Prosperity Dr Ste 330 Silver Spring MD 20904-1655 Ph: (301) 604-4033 | Elite Multi Specialty Clinic, Llc 12501 Prosperity Dr Ste 330 Silver Spring MD 20904-1655 Ph: (301) 604-4033 |
NPI Number | 1053758235 |
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Provider Enumeration Date | 05/29/2013 |
Last Update Date | 08/11/2020 |
Medicare PECOS PAC ID | 8123329117 |
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Medicare Enrollment ID | O20151216001859 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053758235 | NPI | - | NPPES |
945614700 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Lendicita Q Madden |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407066723 PECOS PAC ID: 7618124819 Enrollment ID: I20120823000009 |
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