Provider Demographics
NPI:1174279228
Name:ISLAMIC CENTER OF MARYLAND
Entity Type:Organization
Organization Name:ISLAMIC CENTER OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NURUDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-375-0521
Mailing Address - Street 1:19411 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-4726
Mailing Address - Country:US
Mailing Address - Phone:301-375-0521
Mailing Address - Fax:
Practice Address - Street 1:19411 WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-4726
Practice Address - Country:US
Practice Address - Phone:240-477-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health