Provider Demographics
NPI:1376180596
Name:MD MEDICAL AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MD MEDICAL AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-808-0341
Mailing Address - Street 1:4000 MITCHELLVILLE RD STE A308
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3135
Mailing Address - Country:US
Mailing Address - Phone:301-808-0341
Mailing Address - Fax:301-263-6860
Practice Address - Street 1:4000 MITCHELLVILLE RD STE A308
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3135
Practice Address - Country:US
Practice Address - Phone:301-808-0341
Practice Address - Fax:301-263-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care