Provider Demographics
NPI:1346506219
Name:MCLMHP INC.
Entity Type:Organization
Organization Name:MCLMHP INC.
Other - Org Name:PROYECTO SALUD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:301-962-6173
Mailing Address - Street 1:2424 REEDIE DRIVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902
Mailing Address - Country:US
Mailing Address - Phone:301-962-6173
Mailing Address - Fax:301-962-5733
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 312
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-260-1073
Practice Address - Fax:301-260-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11927261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health