Provider Demographics
NPI:1447582267
Name:ACCESS FAMILY PRACTICE AND WALK-IN CLINIC
Entity Type:Organization
Organization Name:ACCESS FAMILY PRACTICE AND WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MODUPE
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:TOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC, PMHNP
Authorized Official - Phone:410-963-3993
Mailing Address - Street 1:3110 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2023
Mailing Address - Country:US
Mailing Address - Phone:410-298-1931
Mailing Address - Fax:410-298-1932
Practice Address - Street 1:3110 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2023
Practice Address - Country:US
Practice Address - Phone:410-298-1931
Practice Address - Fax:410-298-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care