| Bowie Town Behavioral | |
|
4000 Mitchellville Rd Ste A414 Bowie MD 20716-3142 | |
| (301) 249-8100 | |
| (301) 390-8086 |
| Full Name | Bowie Town Behavioral |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4000 Mitchellville Rd Ste A414, Bowie, Maryland |
| Authorized Official Name and Position | Ayokunle Oluleye (DIRECTOR) |
| Authorized Official Contact | 4437565092 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bowie Town Behavioral 4000 Mitchellville Rd Ste A414 Bowie MD 20716-3142 Ph: (301) 249-8100 | Bowie Town Behavioral 4000 Mitchellville Rd Ste A414 Bowie MD 20716-3142 Ph: (301) 249-8100 |
| NPI Number | 1346021813 |
|---|---|
| Provider Enumeration Date | 10/11/2023 |
| Last Update Date | 10/11/2023 |
| Certification Date | 10/11/2023 |
| Medicare PECOS PAC ID | 8820445364 |
|---|---|
| Medicare Enrollment ID | O20231106001927 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346021813 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Dida K Ganjoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265451470 PECOS PAC ID: 4688611874 Enrollment ID: I20070601000350 |
| Provider Name | Rajan Sood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801873898 PECOS PAC ID: 3375592124 Enrollment ID: I20080616000792 |
| Provider Name | Vanessa Osula |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225564628 PECOS PAC ID: 5799054003 Enrollment ID: I20181022001480 |
| Provider Name | Kumutha F Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225627136 PECOS PAC ID: 3173932670 Enrollment ID: I20210513002188 |
| Provider Name | Beserat Legesse Kibret |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578139689 PECOS PAC ID: 9234526120 Enrollment ID: I20220422002197 |
| Provider Name | Sonya Z Chang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639793763 PECOS PAC ID: 3678922978 Enrollment ID: I20231214002605 |
| Provider Name | Stephanie Walker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629548433 PECOS PAC ID: 9436593100 Enrollment ID: I20240221002022 |
| Provider Name | Ibukunoluwa Ayanleye |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265138853 PECOS PAC ID: 8820458516 Enrollment ID: I20240221002869 |
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