Provider Demographics
NPI:1174237200
Name:VIVIS FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:VIVIS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEDWIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGA WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-605-5215
Mailing Address - Street 1:3606 CHANCELSORS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8194
Mailing Address - Country:US
Mailing Address - Phone:240-687-4317
Mailing Address - Fax:218-264-3428
Practice Address - Street 1:3606 CHANCELSORS DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8194
Practice Address - Country:US
Practice Address - Phone:240-687-4317
Practice Address - Fax:218-264-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care