Provider Demographics
NPI:1548601883
Name:ANNAPOLIS FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:ANNAPOLIS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:DABBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-280-9500
Mailing Address - Street 1:104 RIDGELY AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1439
Mailing Address - Country:US
Mailing Address - Phone:410-280-9500
Mailing Address - Fax:443-214-5168
Practice Address - Street 1:104 RIDGELY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1439
Practice Address - Country:US
Practice Address - Phone:410-280-9500
Practice Address - Fax:443-214-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24768261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1326049040OtherNPI