Organization
IMMACULATE MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANN MARIE GORDON MD (CEO)
(202) 877-0400
Entity
Organization
Contact information
Practice address
106 IRVING ST NW, SUITE 308 SOUTH, WASHINGTON, DC 20010-2927
(202) 877-0400
(202) 877-0584
Mailing address
2016 GATEWOOD PL, SILVER SPRING, MD 20903-1505
(301) 257-5033
(301) 408-3204
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD22148
DC
261QX0100X
Occupational Medicine Clinic/Center
MD22148
DC
Other
Enumeration date
07/19/2010
Last updated
02/15/2011
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