Provider Demographics
NPI:1184098634
Name:MMLC URGENT CARE WOUND CARE SERVICES LLC
Entity type:Organization
Organization Name:MMLC URGENT CARE WOUND CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:AMMAAN
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-585-1833
Mailing Address - Street 1:1300 SPRING ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3616
Mailing Address - Country:US
Mailing Address - Phone:301-585-1833
Mailing Address - Fax:301-448-1202
Practice Address - Street 1:1300 SPRING ST
Practice Address - Street 2:SUITE 122
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3616
Practice Address - Country:US
Practice Address - Phone:304-585-1833
Practice Address - Fax:301-448-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064592207Q00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD032809000Medicaid
MD7578010001OtherMEDICARE PTAN