Provider Demographics
NPI:1407528862
Name:DYNMED PRIMARY CARE AND WELLNESS P. A
Entity Type:Organization
Organization Name:DYNMED PRIMARY CARE AND WELLNESS P. A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-526-1004
Mailing Address - Street 1:6510 KENILWORTH AVE STE 2700
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1353
Mailing Address - Country:US
Mailing Address - Phone:301-526-1004
Mailing Address - Fax:
Practice Address - Street 1:6510 KENILWORTH AVE STE 2700
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1353
Practice Address - Country:US
Practice Address - Phone:301-526-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNMED PRIMARY CARE AND WELLNESS P. A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty