Provider Demographics
NPI:1831615384
Name:ADORN MEDICAL CARE SERVICES
Entity type:Organization
Organization Name:ADORN MEDICAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEBANGSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-486-2783
Mailing Address - Street 1:110801 BISHOPS CONTENT RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2570
Mailing Address - Country:US
Mailing Address - Phone:301-792-0816
Mailing Address - Fax:
Practice Address - Street 1:4514 BENNING RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5149
Practice Address - Country:US
Practice Address - Phone:202-800-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN963620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD551020100Medicaid