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Active
Organization subpart
No

Provider details

NPI number
Authorized official
ABDUL I MAGONA (ADMINISTRATOR)
(240) 542-4195
Entity
Organization

Contact information

Practice address
5020 SUNNYSIDE AVE STE 222, BELTSVILLE, MD 20705-2307
(240) 542-4195
Mailing address
5020 SUNNYSIDE AVE STE 222, BELTSVILLE, MD 20705-2307

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
423382400
MD
Enumeration date
12/14/2017
Last updated
12/14/2017
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