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2327 Pennsylvania Ave Baltimore MD 21217-2827 | |
| (301) 455-9785 | |
| (866) 450-1117 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2327 Pennsylvania Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Oluremi Michelle Ayoh (CEO) |
| Authorized Official Contact | 3014559785 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2327 Pennsylvania Ave Baltimore MD 21217-2827 Ph: (301) 455-9785 | 2327 Pennsylvania Ave Baltimore MD 21217-2827 Ph: (301) 455-9785 |
| NPI Number | 1871283739 |
|---|---|
| Provider Enumeration Date | 05/12/2023 |
| Last Update Date | 01/16/2025 |
| Certification Date | 01/16/2025 |
| Medicare PECOS PAC ID | 9830637750 |
|---|---|
| Medicare Enrollment ID | O20240809002527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871283739 | NPI | - | NPPES |
| Provider Name | Jacklyn A Amankwa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184101552 PECOS PAC ID: 0749728665 Enrollment ID: I20240809002835 |
| Provider Name | Ozichukwu O Awusah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275225252 PECOS PAC ID: 1951840875 Enrollment ID: I20240823000478 |
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