Provider Demographics
NPI:1427865583
Name:FOUNDATIONAL MEDICINE LLC
Entity type:Organization
Organization Name:FOUNDATIONAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-231-4325
Mailing Address - Street 1:2339 DECKMAN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2262
Mailing Address - Country:US
Mailing Address - Phone:503-891-2142
Mailing Address - Fax:240-744-7538
Practice Address - Street 1:2339 DECKMAN LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2262
Practice Address - Country:US
Practice Address - Phone:503-891-2142
Practice Address - Fax:240-744-7538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty