Provider Demographics
NPI:1972223048
Name:CHARISS FAMILY MEDICAL CLINIC AND MEDICAL SPA INC
Entity Type:Organization
Organization Name:CHARISS FAMILY MEDICAL CLINIC AND MEDICAL SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EKEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-938-4918
Mailing Address - Street 1:9470 ANNAPOLIS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3025
Mailing Address - Country:US
Mailing Address - Phone:240-770-4315
Mailing Address - Fax:240-770-4417
Practice Address - Street 1:9470 ANNAPOLIS RD STE 401
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:240-770-4315
Practice Address - Fax:240-770-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)