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600 N Wolfe St Baltimore MD 21287-0005 | |
| (410) 933-1329 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 600 N Wolfe St, Baltimore, Maryland |
| Authorized Official Name and Position | Shavonda L Keating (SR PRODUCTION UNIT MGR) |
| Authorized Official Contact | 4109336430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 64227 Baltimore MD 21264-4227 Ph: (410) 933-6423 | 600 N Wolfe St Baltimore MD 21287-0005 Ph: (410) 933-1329 |
| NPI Number | 1356346100 |
|---|---|
| Provider Enumeration Date | 06/17/2005 |
| Last Update Date | 07/21/2022 |
| Certification Date | 03/07/2021 |
| Medicare PECOS PAC ID | 4981745098 |
|---|---|
| Medicare Enrollment ID | O20150624002277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356346100 | NPI | - | NPPES |
| CC8404 | Other | MD | RRMC |
| 132861100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Maryland) | Primary |
| Provider Name | Kelly Mills |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1083867055 PECOS PAC ID: 3072775949 Enrollment ID: I20150625000290 |
| Provider Name | Elliott N Exar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1235225723 PECOS PAC ID: 5395827240 Enrollment ID: I20160523002254 |
| Provider Name | Bardia Nourbakhsh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760709976 PECOS PAC ID: 2466676986 Enrollment ID: I20170302000514 |
| Provider Name | Ricardo Horacio Roda |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396897898 PECOS PAC ID: 8325279730 Enrollment ID: I20180413000346 |
| Provider Name | Daniel Ross Gold |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487889820 PECOS PAC ID: 0244474484 Enrollment ID: I20191120000047 |
| Provider Name | Anne Damian Yacoub |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134672918 PECOS PAC ID: 5193019396 Enrollment ID: I20201012002429 |
| Provider Name | Dian Grandison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083137970 PECOS PAC ID: 6305255241 Enrollment ID: I20210607001218 |
| Provider Name | Saeed Ansari Sadrabadi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1952729113 PECOS PAC ID: 3274752431 Enrollment ID: I20210907002334 |
| Provider Name | David Newman-toker |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073566873 PECOS PAC ID: 5395984207 Enrollment ID: I20231013000687 |
| Provider Name | Rachel Marie Salas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407900210 PECOS PAC ID: 2769555853 Enrollment ID: I20240517000269 |
| Provider Name | Sara Benjamin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1336161447 PECOS PAC ID: 1355343047 Enrollment ID: I20240611000985 |
| Provider Name | Laura Sterni |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1790715464 PECOS PAC ID: 3779640610 Enrollment ID: I20240709003094 |
| Provider Name | Charlene Gamaldo |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1447200571 PECOS PAC ID: 0244259299 Enrollment ID: I20240709004438 |
| Provider Name | Tracey Stierer |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1760414098 PECOS PAC ID: 0941484182 Enrollment ID: I20240712000281 |
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