| Rehoboth Medical Center Llc | |
|
11223 Lockwood Dr Silver Spring MD 20901-4554 | |
| (240) 254-3375 | |
| (410) 844-6442 |
| Full Name | Rehoboth Medical Center Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 11223 Lockwood Dr, Silver Spring, Maryland |
| Authorized Official Name and Position | Kathryn Maduforo (CEO) |
| Authorized Official Contact | 2402543375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rehoboth Medical Center Llc 6504 94th Ave Lanham MD 20706-3402 Ph: (240) 254-3375 | Rehoboth Medical Center Llc 11223 Lockwood Dr Silver Spring MD 20901-4554 Ph: (240) 254-3375 |
| NPI Number | 1356980270 |
|---|---|
| Provider Enumeration Date | 12/23/2019 |
| Last Update Date | 08/04/2021 |
| Medicare PECOS PAC ID | 5890124861 |
|---|---|
| Medicare Enrollment ID | O20200327000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356980270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kathryn Adebukola Maduforo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750946729 PECOS PAC ID: 7618306697 Enrollment ID: I20200327000235 |
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