| Advanced Functional Health And Wellness | |
|
9711 Washingtonian Blvd Ste 550 Gaithersburg MD 20878-5789 | |
| (301) 966-2558 | |
| Not Available |
| Full Name | Advanced Functional Health And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 9711 Washingtonian Blvd Ste 550, Gaithersburg, Maryland |
| Authorized Official Name and Position | Louis Gbone (MANAGER) |
| Authorized Official Contact | 2404263133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Functional Health And Wellness 3731 Spicebush Dr Frederick MD 21704-7879 Ph: (301) 966-2558 | Advanced Functional Health And Wellness 9711 Washingtonian Blvd Ste 550 Gaithersburg MD 20878-5789 Ph: (301) 966-2558 |
| NPI Number | 1730450990 |
|---|---|
| Provider Enumeration Date | 01/19/2012 |
| Last Update Date | 09/21/2021 |
| Medicare PECOS PAC ID | 7012175904 |
|---|---|
| Medicare Enrollment ID | O20120223000367 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730450990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D0069829 (Maryland) | Primary |
| Provider Name | Shukdeo Sankar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871823468 PECOS PAC ID: 0840415709 Enrollment ID: I20140709000551 |
| Provider Name | Bethany Roderer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730458571 PECOS PAC ID: 2961728522 Enrollment ID: I20150226001178 |
| Provider Name | Olukemi B Ogunmakinwa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629439948 PECOS PAC ID: 9133408453 Enrollment ID: I20161109001372 |
| Provider Name | Mercy Eseme |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891191946 PECOS PAC ID: 8921360355 Enrollment ID: I20180326000114 |
| Provider Name | Larissa Gbone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467925909 PECOS PAC ID: 9638417298 Enrollment ID: I20190207000083 |
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