| |
9171 Central Ave Units B11 & B12 Capitol Heights MD 20743-3837 | |
(240) 294-6058 | |
(240) 640-6155 |
Full Name | |
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Speciality | Family Medicine |
Location | 9171 Central Ave, Capitol Heights, Maryland |
Authorized Official Name and Position | Toyin O Opesanmi (MEDICAL DIRECTOR) |
Authorized Official Contact | 4109635870 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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12108 Early Lilacs Path Clarksville MD 21029-1676 Ph: (410) 963-5870 | 9171 Central Ave Units B11 & B12 Capitol Heights MD 20743-3837 Ph: (240) 294-6058 |
NPI Number | 1770912149 |
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Provider Enumeration Date | 11/06/2013 |
Last Update Date | 06/30/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770912149 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | D0059876 (Maryland) | Primary |
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