Lakewood Family Clinic | |
1400 Mercantile Ln Ste 180 Largo MD 20774-5369 | |
(301) 925-7022 | |
(301) 925-7022 |
Full Name | Lakewood Family Clinic |
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Speciality | Clinic/Center |
Location | 1400 Mercantile Ln Ste 180, Largo, Maryland |
Authorized Official Name and Position | Monisola Augusta Adeyemo (NP) |
Authorized Official Contact | 3019257022 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lakewood Family Clinic 1400 Mercantile Lane #180 Largo MD 20774 Ph: (301) 925-7022 | Lakewood Family Clinic 1400 Mercantile Ln Ste 180 Largo MD 20774-5369 Ph: (301) 925-7022 |
NPI Number | 1366651598 |
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Provider Enumeration Date | 05/22/2007 |
Last Update Date | 11/08/2007 |
Medicare PECOS PAC ID | 5092893578 |
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Medicare Enrollment ID | O20080424000069 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366651598 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | 105387 (Maryland) | Primary |
Provider Name | Monisola A Adeyemo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1881754349 PECOS PAC ID: 2466530944 Enrollment ID: I20080424000066 |
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