Provider Demographics
NPI:1578217196
Name:CITYWORLD FAMILY PRACTICE
Entity Type:Organization
Organization Name:CITYWORLD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MBUTAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:202-367-3927
Mailing Address - Street 1:7700 OLD BRANCH AVE STE B201
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1605
Mailing Address - Country:US
Mailing Address - Phone:202-658-6844
Mailing Address - Fax:202-618-6201
Practice Address - Street 1:7603 GEORGIA AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1617
Practice Address - Country:US
Practice Address - Phone:202-658-6844
Practice Address - Fax:202-618-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC085465599Medicaid