Provider Demographics
NPI:1699149013
Name:GREENWAY FAMILY MEDICAL PRACTICE, LLC
Entity type:Organization
Organization Name:GREENWAY FAMILY MEDICAL PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-313-0425
Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:105
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-313-0425
Mailing Address - Fax:301-313-0435
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:105
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-313-0425
Practice Address - Fax:301-313-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207Q00000X, 207R00000X, 208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty