Provider Demographics
NPI:1174331243
Name:OLD GREENBELT FAMILY HEALTH
Entity type:Organization
Organization Name:OLD GREENBELT FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-670-7156
Mailing Address - Street 1:115 CENTERWAY STE 104
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1836
Mailing Address - Country:US
Mailing Address - Phone:240-424-0697
Mailing Address - Fax:
Practice Address - Street 1:115 CENTERWAY STE 104
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1836
Practice Address - Country:US
Practice Address - Phone:240-424-0697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD GREENBELT FAMILY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty