Provider Demographics
NPI:1881139954
Name:COMPREHENSIVE MEDICAL CARE & WALK IN CLINIC, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE & WALK IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-799-1661
Mailing Address - Street 1:6676 DASHER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-8202
Mailing Address - Country:US
Mailing Address - Phone:443-799-1661
Mailing Address - Fax:866-596-1084
Practice Address - Street 1:610 PROFESSIONAL DR
Practice Address - Street 2:SUITE # 235
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3413
Practice Address - Country:US
Practice Address - Phone:301-740-9055
Practice Address - Fax:866-596-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143399261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR143399OtherMARYLAND LICENSE