| Preventive Care Network Services Pc | |
|
9001 Woodyard Rd Ste C Clinton MD 20735 | |
| (301) 868-7333 | |
| (301) 868-9023 |
| Full Name | Preventive Care Network Services Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9001 Woodyard Rd Ste C, Clinton, Maryland |
| Authorized Official Name and Position | Denise Herry (MEDICAL CODER/BILLER) |
| Authorized Official Contact | 3018687333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Preventive Care Network Services Pc 9001 Woodyard Rd Ste C Clinton MD 20735-4264 Ph: (301) 868-7333 | Preventive Care Network Services Pc 9001 Woodyard Rd Ste C Clinton MD 20735 Ph: (301) 868-7333 |
| NPI Number | 1407913296 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 06/12/2018 |
| Medicare PECOS PAC ID | 6709867351 |
|---|---|
| Medicare Enrollment ID | O20040528000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407913296 | NPI | - | NPPES |
| 183731100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Desmond Fitzroy Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104960616 PECOS PAC ID: 7012101173 Enrollment ID: I20101102001140 |
| Provider Name | Victor E Herry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073642625 PECOS PAC ID: 6709068679 Enrollment ID: I20110314000863 |
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