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705 Bayfield St Takoma Park MD 20912-7307 | |
| (301) 431-7603 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 705 Bayfield St, Takoma Park, Maryland |
| Authorized Official Name and Position | Jameelah Johnson (MANAGER) |
| Authorized Official Contact | 2407731211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
401 Hungerford Dr Fl 6 Rockville MD 20850-4154 Ph: (240) 777-4520 | 705 Bayfield St Takoma Park MD 20912-7307 Ph: (301) 431-7603 |
| NPI Number | 1033478292 |
|---|---|
| Provider Enumeration Date | 05/09/2012 |
| Last Update Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033478292 | NPI | - | NPPES |
| 625403900 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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