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4607 69th Ave Hyattsville MD 20784-2123 | |
| (301) 821-1671 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4607 69th Ave, Hyattsville, Maryland |
| Authorized Official Name and Position | Ben Ijomah (PROGRAM DIRECTOR) |
| Authorized Official Contact | 3018211671 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4607 69th Ave Hyattsville MD 20784-2123 Ph: (301) 821-1671 | 4607 69th Ave Hyattsville MD 20784-2123 Ph: (301) 821-1671 |
| NPI Number | 1568959112 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 04/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568959112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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