Provider Demographics
NPI:1902594179
Name:ADVANCED TELE CLINIC
Entity Type:Organization
Organization Name:ADVANCED TELE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GITHINJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-575-0437
Mailing Address - Street 1:9613 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9613 BLOCK ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2586
Practice Address - Country:US
Practice Address - Phone:240-575-0437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care