Provider Demographics
NPI:1184866170
Name:JOAN P MEDWAY, P.A.
Entity Type:Organization
Organization Name:JOAN P MEDWAY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-279-2667
Mailing Address - Street 1:10008 COLEBROOK AVENUE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1807
Mailing Address - Country:US
Mailing Address - Phone:301-279-2667
Mailing Address - Fax:
Practice Address - Street 1:10008 COLEBROOK AVENUE
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1807
Practice Address - Country:US
Practice Address - Phone:301-279-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD#2521 LCSW-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty