Provider Demographics
NPI:1417700717
Name:WASHINGTON MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:WASHINGTON MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:NWAKEGO
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-908-2116
Mailing Address - Street 1:12515 OLD GUNPOWDER RD
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1151
Mailing Address - Country:US
Mailing Address - Phone:301-908-2116
Mailing Address - Fax:301-326-4545
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE STE 340
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1400
Practice Address - Country:US
Practice Address - Phone:301-750-8000
Practice Address - Fax:301-326-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty