Provider Demographics
NPI:1376632323
Name:PROHEALTHCARE, LLC
Entity Type:Organization
Organization Name:PROHEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-916-7861
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-2185
Mailing Address - Country:US
Mailing Address - Phone:301-916-7861
Mailing Address - Fax:301-916-5267
Practice Address - Street 1:19519 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5247
Practice Address - Country:US
Practice Address - Phone:301-916-7861
Practice Address - Fax:301-916-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99653Medicare UPIN
G01818P01Medicare ID - Type Unspecified