Organization
HERITAGE MEDICAL PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYAH TANIFORM (OWNER)
(817) 608-7454
Entity
Organization
Contact information
Practice address
10600 MELWOOD CHAPEL LN, UPPER MARLBORO, MD 20772-2960
(817) 608-7454
Mailing address
10600 MELWOOD CHAPEL LN, UPPER MARLBORO, MD 20772-2960
(817) 608-7454
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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