Provider Demographics
NPI:1689399032
Name:GIFTED PRIMARY CARE LLC
Entity type:Organization
Organization Name:GIFTED PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NYEDIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEGHANG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-357-1167
Mailing Address - Street 1:3060 MITCHELLVILLE RD
Mailing Address - Street 2:STE 106A
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:301-357-1167
Mailing Address - Fax:
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:STE 106A
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-357-1167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD881911400Medicaid