Provider Demographics
NPI:1770085029
Name:HEALING VESSEL MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:HEALING VESSEL MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOREGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-335-3941
Mailing Address - Street 1:14903 DENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3277
Mailing Address - Country:US
Mailing Address - Phone:301-335-3941
Mailing Address - Fax:
Practice Address - Street 1:14903 DENNINGTON DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3277
Practice Address - Country:US
Practice Address - Phone:301-335-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty