Provider Demographics
NPI:1659782126
Name:METROPOLITAN ELITE FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:METROPOLITAN ELITE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-317-8660
Mailing Address - Street 1:3450 LAUREL FORT MEADE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2040
Mailing Address - Country:US
Mailing Address - Phone:301-317-8660
Mailing Address - Fax:301-317-8663
Practice Address - Street 1:3450 LAUREL FORT MEADE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-317-8660
Practice Address - Fax:301-317-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD053840261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD744101100Medicaid
MD744101100Medicaid