Provider Demographics
NPI:1942552815
Name:LOMACK PRIMARY CARE, INC
Entity Type:Organization
Organization Name:LOMACK PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NKIRU
Authorized Official - Middle Name:JULIANA
Authorized Official - Last Name:EZEANI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-593-1700
Mailing Address - Street 1:11120 NEW HAMPSHIRE AVE
Mailing Address - Street 2:507
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2633
Mailing Address - Country:US
Mailing Address - Phone:301-593-1700
Mailing Address - Fax:301-593-1701
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE
Practice Address - Street 2:507
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2633
Practice Address - Country:US
Practice Address - Phone:301-593-1700
Practice Address - Fax:301-593-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151747261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412879600Medicaid