N/a | |
2323 Maryland Ave. Suite 1a Suite 1a Baltimore MD 21218-5029 | |
(443) 934-0084 | |
Not Available |
Full Name | N/a |
---|---|
Speciality | Clinic/Center |
Location | 2323 Maryland Ave. Suite 1a, Baltimore, Maryland |
Authorized Official Name and Position | Jimoh Adebayo (PRESIDENT/CEO) |
Authorized Official Contact | 2405154868 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
N/a 2323 Maryland Ave. Suite 1a Suite 1a Baltimore MD 21218-5029 Ph: (443) 934-0084 | N/a 2323 Maryland Ave. Suite 1a Suite 1a Baltimore MD 21218-5029 Ph: (443) 934-0084 |
NPI Number | 1609470327 |
---|---|
Provider Enumeration Date | 11/23/2020 |
Last Update Date | 08/15/2023 |
Certification Date | 08/15/2023 |
Medicare PECOS PAC ID | 9931553740 |
---|---|
Medicare Enrollment ID | O20230927004336 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609470327 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Provider Name | Ejobosele Ikhajiagbe |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619648367 PECOS PAC ID: 7911380985 Enrollment ID: I20220824001664 |
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