| Graceland Psychiatry Llc | |
|
10451 Mill Run Cir Owings Mills MD 21117-5577 | |
| (888) 517-4888 | |
| Not Available |
| Full Name | Graceland Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10451 Mill Run Cir, Owings Mills, Maryland |
| Authorized Official Name and Position | Adetimbo Adediran (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 2407229763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceland Psychiatry Llc 9435 Paragon Ct Owings Mills MD 21117-1408 Ph: (240) 722-9763 | Graceland Psychiatry Llc 10451 Mill Run Cir Owings Mills MD 21117-5577 Ph: (888) 517-4888 |
| NPI Number | 1265011928 |
|---|---|
| Provider Enumeration Date | 04/07/2021 |
| Last Update Date | 06/16/2021 |
| Certification Date | 06/16/2021 |
| Medicare PECOS PAC ID | 2062813801 |
|---|---|
| Medicare Enrollment ID | O20210630001541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265011928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Adetimbo Adediran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679922298 PECOS PAC ID: 4082902937 Enrollment ID: I20161011000053 |
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