Provider Demographics
NPI:1841529617
Name:MADANI FAMILY CENTER
Entity type:Organization
Organization Name:MADANI FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER & CREDENTIALLING
Authorized Official - Prefix:
Authorized Official - First Name:AMINATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-313-0425
Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-313-0425
Mailing Address - Fax:301-313-0435
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 213
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-313-0425
Practice Address - Fax:301-313-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD492228Medicare PIN