| Waldorf Primary Care LLC | |
|
3460 Old Washington Rd Suite 103 Waldorf MD 20602-3240 | |
| (301) 638-0001 | |
| (301) 638-5454 |
| Full Name | Waldorf Primary Care LLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3460 Old Washington Rd, Waldorf, Maryland |
| Authorized Official Name and Position | Karlene Vanessa Ross (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3016380001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Waldorf Primary Care LLC 3460 Old Washington Rd Suite 103 Waldorf MD 20602-3240 Ph: (301) 638-0001 | Waldorf Primary Care LLC 3460 Old Washington Rd Suite 103 Waldorf MD 20602-3240 Ph: (301) 638-0001 |
| NPI Number | 1356598379 |
|---|---|
| Provider Enumeration Date | 08/20/2008 |
| Last Update Date | 11/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356598379 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D0066434 (Maryland) | Primary |
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