Provider Demographics
NPI:1174772750
Name:A-FRAGILE HEART AND ASSOCIATES,LLC
Entity type:Organization
Organization Name:A-FRAGILE HEART AND ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LAWANDA
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-431-8455
Mailing Address - Street 1:15309 JOHNSTONE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7275
Mailing Address - Country:US
Mailing Address - Phone:301-218-8836
Mailing Address - Fax:301-218-8836
Practice Address - Street 1:15309 JOHNSTONE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7275
Practice Address - Country:US
Practice Address - Phone:301-218-8836
Practice Address - Fax:301-218-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization