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4155 Glen Park Rd Nottingham MD 21236-1019 | |
| (410) 248-0661 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4155 Glen Park Rd, Nottingham, Maryland |
| Authorized Official Name and Position | Greg Tampus (OWNER) |
| Authorized Official Contact | 4439300161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4155 Glen Park Rd Nottingham MD 21236-1019 Ph: (410) 248-0661 | 4155 Glen Park Rd Nottingham MD 21236-1019 Ph: (410) 248-0661 |
| NPI Number | 1194592220 |
|---|---|
| Provider Enumeration Date | 12/08/2023 |
| Last Update Date | 12/08/2023 |
| Certification Date | 12/08/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194592220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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