NPIMap

Organization Active NPI

Fit for Life Medical Center Inc

  • Family Medicine Physician
  • Bowie, MD
National Provider Identifier
1497934426
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0042719 Issued in MD
Legal business name
FIT FOR LIFE MEDICAL CENTER INC
Practice address
14300 Gallant Fox LN
Ste 118
Bowie, MD 20715-4003
Phone
(301) 805-4348
Fax
(301) 805-6779
NPI assigned
Oct 26, 2007
Last updated
Apr 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dawne M Carroll, MDNPI 1902917628
Title
Medical Director
Phone
(301) 818-1243

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X D0042719 MD Primary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 0101041759 VA
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X MD16892 DC

Addresses

Primary practice location

14300 Gallant Fox LN
Ste 118
Bowie, MD 20715-4003

Mailing address

12138 Central Ave Ste 953
Bowie, MD 20721-1910
Phone (301) 818-1243

Other identifiers 3

IdentifierTypeStateIssuer
032383200MedicaidDC
010001331MedicaidVA
1829017MedicaidMD

National Provider Directory

National Provider Directory

Locations

1600 Crystal Square Arc
Ste K
Arlington, VA 22202
Phone (703) 418-1370

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1497934426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12138 CENTRAL AVE STE 953",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207211910",
            "telephone_number": "301-818-1243",
            "fax_number": "240-435-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14300 GALLANT FOX LN",
            "address_2": "STE 118",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207154003",
            "telephone_number": "301-805-4348",
            "fax_number": "301-805-6779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIT FOR LIFE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-26",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "DAWNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-818-1243",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0042719",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101041759",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "DC",
            "license": "MD16892",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032383200",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010001331",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1829017",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.