Provider Demographics
NPI:1689399032
Name:GIFTED PRIMARY CARE LLC
Entity Type:Organization
Organization Name:GIFTED PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NYEDIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEGHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-838-2560
Mailing Address - Street 1:15020 RUNNING PARK CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3377
Mailing Address - Country:US
Mailing Address - Phone:240-838-2560
Mailing Address - Fax:
Practice Address - Street 1:15020 RUNNING PARK CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3377
Practice Address - Country:US
Practice Address - Phone:240-838-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care