Provider Demographics
NPI:1871874859
Name:EZE FAMILY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:EZE FAMILY HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTITIONER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:301-323-3921
Mailing Address - Street 1:11750 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2907
Mailing Address - Country:US
Mailing Address - Phone:301-323-3921
Mailing Address - Fax:888-519-5179
Practice Address - Street 1:11750 BUSINESS PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2907
Practice Address - Country:US
Practice Address - Phone:301-323-3921
Practice Address - Fax:888-519-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69441261Q00000X
MDD0037088261Q00000X
MDC0004111363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1003032855OtherNPPES (NPI)