Organization
FIT FOR LIFE MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWNE M CARROLL MD (MEDICAL DIRECTOR)
(301) 818-1243
Entity
Organization
Contact information
Practice address
14300 GALLANT FOX LN, STE 118, BOWIE, MD 20715-4003
(301) 805-4348
(301) 805-6779
Mailing address
12138 CENTRAL AVE STE 953, BOWIE, MD 20721-1910
(301) 818-1243
(240) 435-2692
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101041759
VA
207Q00000X
Family Medicine Physician
Primary
D0042719
MD
207Q00000X
Family Medicine Physician
MD16892
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010001331
—
VA
05
—
032383200
—
DC
05
—
1829017
—
MD
Enumeration date
10/26/2007
Last updated
04/13/2023
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