Provider Demographics
NPI:1326714361
Name:DGENESIS
Entity Type:Organization
Organization Name:DGENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUEEN B
Authorized Official - Middle Name:O
Authorized Official - Last Name:MUMUNEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:301-442-5109
Mailing Address - Street 1:6180 SCAGGS RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-4208
Mailing Address - Country:US
Mailing Address - Phone:301-442-5109
Mailing Address - Fax:
Practice Address - Street 1:6180 SCAGGS RD
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-4208
Practice Address - Country:US
Practice Address - Phone:301-442-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center