| Meditelecare Of Maryland Llc | |
|
7 Saint Paul St Ste 820 Baltimore MD 21202-1681 | |
| (860) 788-6404 | |
| (860) 829-0495 |
| Full Name | Meditelecare Of Maryland Llc |
|---|---|
| Speciality | Psychologist |
| Location | 7 Saint Paul St Ste 820, Baltimore, Maryland |
| Authorized Official Name and Position | Andrea Godfrey (CREDENTIALING & ENROLLMENT MANAGER) |
| Authorized Official Contact | 8607886404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of Maryland Llc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of Maryland Llc 7 Saint Paul St Ste 820 Baltimore MD 21202-1681 Ph: (860) 788-6404 |
| NPI Number | 1083297089 |
|---|---|
| Provider Enumeration Date | 04/28/2021 |
| Last Update Date | 09/04/2024 |
| Certification Date | 09/04/2024 |
| Medicare PECOS PAC ID | 2769881440 |
|---|---|
| Medicare Enrollment ID | O20210528002286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083297089 | NPI | - | NPPES |
| Provider Name | Margaret Isoh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104436526 PECOS PAC ID: 9335552009 Enrollment ID: I20210120000293 |
| Provider Name | Julio Antonio Enriquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689981904 PECOS PAC ID: 5799083374 Enrollment ID: I20210601000836 |
| Provider Name | Barbara Hutchinson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528255643 PECOS PAC ID: 8426284308 Enrollment ID: I20210621000013 |
| Provider Name | Salvi M Alday |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871239954 PECOS PAC ID: 2961884721 Enrollment ID: I20220804000093 |
| Provider Name | Timothy Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740346253 PECOS PAC ID: 7810218658 Enrollment ID: I20230207001881 |
| Provider Name | Kelly Rice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588336234 PECOS PAC ID: 4981092715 Enrollment ID: I20231204002628 |
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