| Envisioncare Medical Associates, Llc | |
|
10507 Montana Ter Upper Marlboro MD 20774-6034 | |
| (301) 237-7383 | |
| (301) 322-9555 |
| Full Name | Envisioncare Medical Associates, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10507 Montana Ter, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Chinwe N Ndubisi (MEDICAL PRACTITIONER) |
| Authorized Official Contact | 3012377383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envisioncare Medical Associates, Llc 1400 Mercantile Ln Suite 124 Largo MD 20774-5341 Ph: (301) 322-9292 | Envisioncare Medical Associates, Llc 10507 Montana Ter Upper Marlboro MD 20774-6034 Ph: (301) 237-7383 |
| NPI Number | 1578729331 |
|---|---|
| Provider Enumeration Date | 07/31/2008 |
| Last Update Date | 07/31/2008 |
| Medicare PECOS PAC ID | 6901974138 |
|---|---|
| Medicare Enrollment ID | O20081017000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578729331 | NPI | - | NPPES |
| 1770745184 | Other | MD | NPI-CMS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | NP117688 (Maryland) | Primary |
| Provider Name | Chinwe N Ndubisi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770745184 PECOS PAC ID: 1759459985 Enrollment ID: I20081007000319 |
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