| Fit For Life Medical Center Inc | |
|
14300 Gallant Fox Ln Ste 118 Bowie MD 20715-4003 | |
| (301) 805-4348 | |
| (301) 805-6779 |
| Full Name | Fit For Life Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 14300 Gallant Fox Ln, Bowie, Maryland |
| Authorized Official Name and Position | Dawne M Carroll (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3018181243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fit For Life Medical Center Inc 12138 Central Ave Ste 953 Bowie MD 20721-1910 Ph: (301) 818-1243 | Fit For Life Medical Center Inc 14300 Gallant Fox Ln Ste 118 Bowie MD 20715-4003 Ph: (301) 805-4348 |
| NPI Number | 1497934426 |
|---|---|
| Provider Enumeration Date | 10/26/2007 |
| Last Update Date | 04/13/2023 |
| Medicare PECOS PAC ID | 8123089463 |
|---|---|
| Medicare Enrollment ID | O20041020001092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497934426 | NPI | - | NPPES |
| 032383200 | Medicaid | DC | |
| 010001331 | Medicaid | VA | |
| 1829017 | Medicaid | MD |
| Provider Name | Dawne M Carroll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902917628 PECOS PAC ID: 9739140070 Enrollment ID: I20041027000033 |
| Provider Name | Joseph H Avery Iii |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841301769 PECOS PAC ID: 1951477686 Enrollment ID: I20080904000132 |
| Provider Name | Ann Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588965784 PECOS PAC ID: 0345410874 Enrollment ID: I20110819000064 |
| Provider Name | Agnes Kallon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043536790 PECOS PAC ID: 6002082815 Enrollment ID: I20111228000713 |
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