Provider Demographics
NPI:1346880440
Name:MYCARE MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:MYCARE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:AMINA
Authorized Official - Last Name:NWOKEJI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:202-341-7678
Mailing Address - Street 1:1509 SOUTHERN SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6074
Mailing Address - Country:US
Mailing Address - Phone:202-341-7678
Mailing Address - Fax:
Practice Address - Street 1:7300 HANOVER DR STE 103
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2250
Practice Address - Country:US
Practice Address - Phone:202-341-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty