Provider Demographics
NPI:1659559912
Name:GREENBELT MEDICAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:GREENBELT MEDICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:NWABUISI
Authorized Official - Last Name:AZINGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACP
Authorized Official - Phone:301-220-3500
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20741-1041
Mailing Address - Country:US
Mailing Address - Phone:301-220-3500
Mailing Address - Fax:301-982-0321
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE M17
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-220-3500
Practice Address - Fax:301-982-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28665Medicare UPIN
G01679Medicare PIN