| Dorothy E Mbellason | |
|
12000 Weathervane Ln Upper Marlboro MD 20772-5015 | |
| (301) 602-1526 | |
| Not Available |
| Full Name | Dorothy E Mbellason |
|---|---|
| Speciality | Clinic/Center |
| Location | 12000 Weathervane Ln, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Dorothy E Mbellason (OWNER) |
| Authorized Official Contact | 3016021526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dorothy E Mbellason 12000 Weathervane Ln Upper Marlboro MD 20772-5015 Ph: (301) 602-1526 | Dorothy E Mbellason 12000 Weathervane Ln Upper Marlboro MD 20772-5015 Ph: (301) 602-1526 |
| NPI Number | 1255049441 |
|---|---|
| Provider Enumeration Date | 11/07/2022 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Medicare PECOS PAC ID | 7214393099 |
|---|---|
| Medicare Enrollment ID | O20230522000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255049441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dorothy Eposi Mbellason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295315117 PECOS PAC ID: 3870993934 Enrollment ID: I20220404000020 |
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