| Maryland Wellness Llc | |
|
4128 Hayward Ave # W Baltimore MD 21215-4340 | |
| (410) 994-6491 | |
| Not Available |
| Full Name | Maryland Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4128 Hayward Ave # W, Baltimore, Maryland |
| Authorized Official Name and Position | Casey Wu (DIRECTOR) |
| Authorized Official Contact | 2146591503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryland Wellness Llc 4128 Hayward Ave # W Baltimore MD 21215-4340 Ph: (410) 994-6491 | Maryland Wellness Llc 4128 Hayward Ave # W Baltimore MD 21215-4340 Ph: (410) 994-6491 |
| NPI Number | 1003479668 |
|---|---|
| Provider Enumeration Date | 04/19/2019 |
| Last Update Date | 03/07/2023 |
| Certification Date | 03/07/2023 |
| Medicare PECOS PAC ID | 6406278803 |
|---|---|
| Medicare Enrollment ID | O20200611002298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003479668 | NPI | - | NPPES |
| 220412460 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412463 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412462 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 907713800 | Medicaid | MD | |
| 220412461 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412464 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| Provider Name | Ashlee Joyce Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083210447 PECOS PAC ID: 9436559416 Enrollment ID: I20210614000129 |
| Provider Name | Rachel Oben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194305771 PECOS PAC ID: 0941603955 Enrollment ID: I20210728003845 |
| Provider Name | Patrice Munford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881292993 PECOS PAC ID: 2961806526 Enrollment ID: I20210804003483 |
| Provider Name | Laurence Joseph Greenwood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386675601 PECOS PAC ID: 6901886217 Enrollment ID: I20210804003843 |
| Provider Name | Amani M Ahmed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063682995 PECOS PAC ID: 8224214747 Enrollment ID: I20210805003681 |
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