Provider Demographics
NPI:1548885346
Name:DORIS COLLABORATIVE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:DORIS COLLABORATIVE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:347-208-7025
Mailing Address - Street 1:7671 MANDRAKE CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7993
Mailing Address - Country:US
Mailing Address - Phone:347-208-7025
Mailing Address - Fax:
Practice Address - Street 1:7671 MANDRAKE CT UNIT 222
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7995
Practice Address - Country:US
Practice Address - Phone:347-208-7025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service