| Activision Fidelity Psychiatric Mental Health Llc | |
|
2409 Baikal Loop Upper Marlboro MD 20774-7051 | |
| (301) 907-1199 | |
| (240) 342-3440 |
| Full Name | Activision Fidelity Psychiatric Mental Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2409 Baikal Loop, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Kenny Amanze (PRESIDENT) |
| Authorized Official Contact | 3019071199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Activision Fidelity Psychiatric Mental Health Llc 2409 Baikal Loop Upper Marlboro MD 20774-7051 Ph: (301) 907-1199 | Activision Fidelity Psychiatric Mental Health Llc 2409 Baikal Loop Upper Marlboro MD 20774-7051 Ph: (301) 907-1199 |
| NPI Number | 1952008880 |
|---|---|
| Provider Enumeration Date | 02/10/2023 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Medicare PECOS PAC ID | 6406212265 |
|---|---|
| Medicare Enrollment ID | O20230520000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952008880 | NPI | - | NPPES |
| Provider Name | Kenny Amanze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962168468 PECOS PAC ID: 4688062375 Enrollment ID: I20230520000086 |
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