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8011 New Hampshire Ave Mobile Unit Hyattsville MD 20783-4612 | |
| (866) 228-9668 | |
| (410) 706-5145 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 8011 New Hampshire Ave, Hyattsville, Maryland |
| Authorized Official Name and Position | Susan Marie Antol (PROGRAM DIRECTOR) |
| Authorized Official Contact | 4107065395 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
655 W Lombard St Suite 425b Baltimore MD 21201-1512 Ph: (410) 706-5395 | 8011 New Hampshire Ave Mobile Unit Hyattsville MD 20783-4612 Ph: (866) 228-9668 |
| NPI Number | 1336515519 |
|---|---|
| Provider Enumeration Date | 08/11/2015 |
| Last Update Date | 08/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336515519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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