Provider Demographics
NPI:1720804347
Name:UTOPIA MEDICAL LLC
Entity type:Organization
Organization Name:UTOPIA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:NGASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-640-5233
Mailing Address - Street 1:4015 WALES LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7997
Mailing Address - Country:US
Mailing Address - Phone:240-375-0384
Mailing Address - Fax:
Practice Address - Street 1:14503 MAIN ST RM A
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3010
Practice Address - Country:US
Practice Address - Phone:240-375-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty