Provider Demographics
NPI:1477283620
Name:GRACEON FAMILY AND WOMENS CLINIC LLC
Entity Type:Organization
Organization Name:GRACEON FAMILY AND WOMENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:OGBUJI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:240-965-7141
Mailing Address - Street 1:7315 HANOVER PKWY STE 1B
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2035
Mailing Address - Country:US
Mailing Address - Phone:240-965-7141
Mailing Address - Fax:240-965-7164
Practice Address - Street 1:7315 HANOVER PKWY STE 1B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2035
Practice Address - Country:US
Practice Address - Phone:240-965-7141
Practice Address - Fax:240-965-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-12
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care