| Innersourced Solutions Llc | |
|
11705 Berry Rd Ste 104 Waldorf MD 20603-5933 | |
| (240) 207-4513 | |
| (240) 846-6037 |
| Full Name | Innersourced Solutions Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11705 Berry Rd Ste 104, Waldorf, Maryland |
| Authorized Official Name and Position | Michelle Dillard (CEO) |
| Authorized Official Contact | 2402074513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innersourced Solutions Llc 11705 Berry Rd Ste 104 Waldorf MD 20603-5933 Ph: (240) 207-4513 | Innersourced Solutions Llc 11705 Berry Rd Ste 104 Waldorf MD 20603-5933 Ph: (240) 207-4513 |
| NPI Number | 1407314420 |
|---|---|
| Provider Enumeration Date | 03/08/2019 |
| Last Update Date | 04/10/2023 |
| Certification Date | 04/10/2023 |
| Medicare PECOS PAC ID | 9335414523 |
|---|---|
| Medicare Enrollment ID | O20171016000314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407314420 | NPI | - | NPPES |
| Provider Name | Aminata Bangura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740841030 PECOS PAC ID: 5991036469 Enrollment ID: I20191015000205 |
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