| Backpack Medical Group Pc | |
|
6655 Santa Barbara Rd Unit 8574 Elkridge MD 21075-7523 | |
| (866) 968-6342 | |
| (855) 615-2876 |
| Full Name | Backpack Medical Group Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6655 Santa Barbara Rd Unit 8574, Elkridge, Maryland |
| Authorized Official Name and Position | Duke Ruktanonchai (PRESIDENT) |
| Authorized Official Contact | 6303064394 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Backpack Medical Group Pc 2023 W Grove Dr Gibsonia PA 15044-6059 Ph: (630) 306-4394 | Backpack Medical Group Pc 6655 Santa Barbara Rd Unit 8574 Elkridge MD 21075-7523 Ph: (866) 968-6342 |
| NPI Number | 1851177570 |
|---|---|
| Provider Enumeration Date | 09/07/2023 |
| Last Update Date | 09/07/2023 |
| Certification Date | 09/07/2023 |
| Medicare PECOS PAC ID | 6507217742 |
|---|---|
| Medicare Enrollment ID | O20240111003427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851177570 | NPI | - | NPPES |
| Provider Name | Ashley B Osborne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710496302 PECOS PAC ID: 0648539486 Enrollment ID: I20180124000325 |
| Provider Name | Jennifer Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902481997 PECOS PAC ID: 5395196547 Enrollment ID: I20240111003566 |
| Provider Name | Angelique Alisia Brathwaite |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952683484 PECOS PAC ID: 8729421748 Enrollment ID: I20240207000743 |
| Provider Name | Danielle Flores |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467069781 PECOS PAC ID: 8022451525 Enrollment ID: I20240212004264 |
| Provider Name | Christina Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922673508 PECOS PAC ID: 2264870211 Enrollment ID: I20240409005007 |
| Provider Name | Olivia F Price |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568175032 PECOS PAC ID: 2365984929 Enrollment ID: I20240611001325 |
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