| Fidicle Business Group, Inc | |
|
9110 Mchenry Ln Lanham MD 20706-4158 | |
| (240) 644-2138 | |
| Not Available |
| Full Name | Fidicle Business Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9110 Mchenry Ln, Lanham, Maryland |
| Authorized Official Name and Position | Clementine Njinkeng (OWNER) |
| Authorized Official Contact | 2406442138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fidicle Business Group, Inc 9110 Mchenry Ln Lanham MD 20706-4158 Ph: (240) 644-2138 | Fidicle Business Group, Inc 9110 Mchenry Ln Lanham MD 20706-4158 Ph: (240) 644-2138 |
| NPI Number | 1063011716 |
|---|---|
| Provider Enumeration Date | 10/23/2020 |
| Last Update Date | 03/10/2022 |
| Medicare PECOS PAC ID | 9032597182 |
|---|---|
| Medicare Enrollment ID | O20220602001177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063011716 | NPI | - | NPPES |
| R209831 | Other | MD | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Clementine Ajong Njinkeng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396007035 PECOS PAC ID: 4587042635 Enrollment ID: I20220602001238 |
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