| Matclinic Physicians Practice Group Llc | |
|
601 7th St Ste 304 Laurel MD 20707-4011 | |
| (410) 220-0280 | |
| (410) 862-0150 |
| Full Name | Matclinic Physicians Practice Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 601 7th St Ste 304, Laurel, Maryland |
| Authorized Official Name and Position | Dan Reck (MANAGER) |
| Authorized Official Contact | 4102200780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Matclinic Physicians Practice Group Llc Po Box 9068 Baltimore MD 21222-0768 Ph: (410) 220-0720 | Matclinic Physicians Practice Group Llc 601 7th St Ste 304 Laurel MD 20707-4011 Ph: (410) 220-0280 |
| NPI Number | 1194217091 |
|---|---|
| Provider Enumeration Date | 06/06/2018 |
| Last Update Date | 05/11/2022 |
| Certification Date | 05/11/2022 |
| Medicare PECOS PAC ID | 3274804349 |
|---|---|
| Medicare Enrollment ID | O20210809000706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194217091 | NPI | - | NPPES |
| 818073300 | Medicaid | MD |
| Provider Name | Joshua Sang Ho Han |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154514859 PECOS PAC ID: 6002991247 Enrollment ID: I20080327000081 |
| Provider Name | Vanessa C Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639179104 PECOS PAC ID: 3476571381 Enrollment ID: I20131101000051 |
| Provider Name | Lashelle Y Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629213152 PECOS PAC ID: 1355491267 Enrollment ID: I20150622000751 |
| Provider Name | Carol W Keating |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669873063 PECOS PAC ID: 6103127733 Enrollment ID: I20160126000778 |
| Provider Name | Jacqueline Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366702862 PECOS PAC ID: 5092740738 Enrollment ID: I20160518000050 |
| Provider Name | Keysha M Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326552647 PECOS PAC ID: 9739449182 Enrollment ID: I20180205001645 |
| Provider Name | Victoria O Ajayi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194221788 PECOS PAC ID: 6204188519 Enrollment ID: I20190109001938 |
| Provider Name | Cecilia L Bibio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316504301 PECOS PAC ID: 7517399892 Enrollment ID: I20200219001666 |
| Provider Name | Augusta Akpabio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134679392 PECOS PAC ID: 3375829922 Enrollment ID: I20200220002404 |
| Provider Name | Nkiru Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205332814 PECOS PAC ID: 4385868884 Enrollment ID: I20200717001765 |
| Provider Name | William Mangana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861018848 PECOS PAC ID: 4981927688 Enrollment ID: I20201008001416 |
| Provider Name | Jumoke Fadeke Omisore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629558572 PECOS PAC ID: 6608286877 Enrollment ID: I20210316002758 |
| Provider Name | Ericka Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558842930 PECOS PAC ID: 4688926991 Enrollment ID: I20210818000743 |
| Provider Name | Adebola Adejuwon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174089239 PECOS PAC ID: 3779811146 Enrollment ID: I20210819001415 |
| Provider Name | Travis Baird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235548314 PECOS PAC ID: 3476853870 Enrollment ID: I20210823000003 |
| Provider Name | Obinneamaka L Iweh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528547767 PECOS PAC ID: 6608109582 Enrollment ID: I20210907000558 |
| Provider Name | Judith Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689800906 PECOS PAC ID: 7517019128 Enrollment ID: I20210924000932 |
| Provider Name | Sadia Cheema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144873043 PECOS PAC ID: 5597094912 Enrollment ID: I20211029000533 |
| Provider Name | Uwaezu Mercy Kalu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558967653 PECOS PAC ID: 2860882750 Enrollment ID: I20211208002259 |
| Provider Name | Sarah Grove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073016143 PECOS PAC ID: 7517222797 Enrollment ID: I20221228001577 |
| Provider Name | Salina A Sahle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699145102 PECOS PAC ID: 2860792918 Enrollment ID: I20230106002388 |
| Provider Name | Ashley Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144870155 PECOS PAC ID: 1557692365 Enrollment ID: I20230317000185 |
| Provider Name | Samantha Nazaroff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467975698 PECOS PAC ID: 0345507844 Enrollment ID: I20230412000115 |
| Provider Name | Lum M Maximuangu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942540083 PECOS PAC ID: 0941597744 Enrollment ID: I20230906004211 |
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