Provider Demographics
NPI:1457641607
Name:HB MEDICAL & WELLNESS SPECIALITY SERVICES, LLC
Entity Type:Organization
Organization Name:HB MEDICAL & WELLNESS SPECIALITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KANIKA HAMPTON
Authorized Official - Middle Name:MOROWA NABULUNGI
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-215-1928
Mailing Address - Street 1:2391 TACOMA PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603
Mailing Address - Country:US
Mailing Address - Phone:202-215-1928
Mailing Address - Fax:
Practice Address - Street 1:2391 TACOMA PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-3853
Practice Address - Country:US
Practice Address - Phone:202-215-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty