Provider Demographics
NPI:1942791421
Name:UNIQUELY URS HAIR RESTORATION CENTER
Entity Type:Organization
Organization Name:UNIQUELY URS HAIR RESTORATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-535-6975
Mailing Address - Street 1:2304 OXFORD SHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3215
Mailing Address - Country:US
Mailing Address - Phone:301-535-6975
Mailing Address - Fax:240-213-2551
Practice Address - Street 1:1144 SMALLWOOD DR W # E1
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4759
Practice Address - Country:US
Practice Address - Phone:301-535-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222859224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222859OtherLICENSE