Provider Demographics
NPI:1396625851
Name:MEDICINE OF ESSENCE
Entity type:Organization
Organization Name:MEDICINE OF ESSENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:AZSE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, STUDENT LPN
Authorized Official - Phone:301-377-3435
Mailing Address - Street 1:7029 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601
Mailing Address - Country:US
Mailing Address - Phone:301-377-3435
Mailing Address - Fax:
Practice Address - Street 1:7029 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3334
Practice Address - Country:US
Practice Address - Phone:301-377-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty