Provider Demographics
NPI:1316397177
Name:SDM-1 STOP PRIMARY & URGENT CARE
Entity Type:Organization
Organization Name:SDM-1 STOP PRIMARY & URGENT CARE
Other - Org Name:LAURE B. NDEUTCHOUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURE
Authorized Official - Middle Name:BERTILLE
Authorized Official - Last Name:NDEUTCHOUA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:240-383-8705
Mailing Address - Street 1:6401 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3201
Mailing Address - Country:US
Mailing Address - Phone:240-383-8705
Mailing Address - Fax:
Practice Address - Street 1:6325 KINSEY TER
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2396
Practice Address - Country:US
Practice Address - Phone:240-383-8705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN1017163261QU0200X
DCRN1017163261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care