Provider Demographics
NPI:1336462787
Name:CENTER FOR HEALTHY LIVING OF MARYLAND
Entity Type:Organization
Organization Name:CENTER FOR HEALTHY LIVING OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-3004
Mailing Address - Street 1:9662 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3670
Mailing Address - Country:US
Mailing Address - Phone:301-856-3004
Mailing Address - Fax:240-269-0081
Practice Address - Street 1:9662 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3670
Practice Address - Country:US
Practice Address - Phone:301-856-3004
Practice Address - Fax:240-269-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00356022080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty