Provider Demographics
NPI:1871088682
Name:COMPASSIONATE WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:COMPASSIONATE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:NGANG
Authorized Official - Last Name:ZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-513-6001
Mailing Address - Street 1:10319 WESTLAKE DR STE 335
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6403
Mailing Address - Country:US
Mailing Address - Phone:240-513-6001
Mailing Address - Fax:240-513-6122
Practice Address - Street 1:44 N POTOMAC ST STE 101&102
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4855
Practice Address - Country:US
Practice Address - Phone:240-513-6001
Practice Address - Fax:240-513-6122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASSIONATE WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70102207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty