Provider Demographics
NPI:1730244047
Name:BOWIE TOWN MEDICAL & URGENT CARE LLC
Entity type:Organization
Organization Name:BOWIE TOWN MEDICAL & URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANJOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-249-8100
Mailing Address - Street 1:3060 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1389
Mailing Address - Country:US
Mailing Address - Phone:301-249-8100
Mailing Address - Fax:301-390-8086
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1389
Practice Address - Country:US
Practice Address - Phone:301-249-8100
Practice Address - Fax:301-390-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty