| Outreach Recovery Ii, Llc | |
|
14205 Park Center Dr # 201202 Laurel MD 20707-5246 | |
| (410) 800-4466 | |
| Not Available |
| Full Name | Outreach Recovery Ii, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 14205 Park Center Dr # 201202, Laurel, Maryland |
| Authorized Official Name and Position | Isiah Coles (COO) |
| Authorized Official Contact | 5615023978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outreach Recovery Ii, Llc 14205 Park Center Dr # 201202 Laurel MD 20707-5246 Ph: (410) 800-4466 | Outreach Recovery Ii, Llc 14205 Park Center Dr # 201202 Laurel MD 20707-5246 Ph: (410) 800-4466 |
| NPI Number | 1427541838 |
|---|---|
| Provider Enumeration Date | 06/11/2018 |
| Last Update Date | 07/31/2024 |
| Certification Date | 07/31/2024 |
| Medicare PECOS PAC ID | 5294166302 |
|---|---|
| Medicare Enrollment ID | O20200505001602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427541838 | NPI | - | NPPES |
| Provider Name | Janet Myrleen Beebe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710981709 PECOS PAC ID: 5890687537 Enrollment ID: I20040428001283 |
| Provider Name | Tonya Lynn Watson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1578608352 PECOS PAC ID: 8628179777 Enrollment ID: I20070719000691 |
| Provider Name | Robert Cadogan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598767691 PECOS PAC ID: 8921084211 Enrollment ID: I20121115000361 |
| Provider Name | Anita Tuli-kendall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285064170 PECOS PAC ID: 0345479663 Enrollment ID: I20140210000011 |
| Provider Name | Ehsan Abdeshahian |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1871844720 PECOS PAC ID: 5496905523 Enrollment ID: I20161117000484 |
| Provider Name | Vikram Gunnala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356414890 PECOS PAC ID: 5597704239 Enrollment ID: I20170920000650 |
| Provider Name | Javonna O Brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417479395 PECOS PAC ID: 2668748351 Enrollment ID: I20171025000221 |
| Provider Name | Dorcas Yahaya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568973113 PECOS PAC ID: 3274893458 Enrollment ID: I20180208000251 |
| Provider Name | Uchechukwu Ifeji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043736846 PECOS PAC ID: 6103189857 Enrollment ID: I20180411002953 |
| Provider Name | Adaku O Ogoke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184121170 PECOS PAC ID: 2668718826 Enrollment ID: I20190108003599 |
| Provider Name | William Haynes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831610161 PECOS PAC ID: 5092086611 Enrollment ID: I20191112002971 |
| Provider Name | Olayinka O Toby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740825413 PECOS PAC ID: 7315371408 Enrollment ID: I20200730001798 |
| Provider Name | Edward J Luschinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205447448 PECOS PAC ID: 1850718529 Enrollment ID: I20200826001040 |
| Provider Name | Crystal Lynne Walls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396222998 PECOS PAC ID: 9931459922 Enrollment ID: I20201013002173 |
| Provider Name | Mary J Cannon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619216835 PECOS PAC ID: 6204130750 Enrollment ID: I20201104003048 |
| Provider Name | Erin Walsh Hebel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457503641 PECOS PAC ID: 4183785959 Enrollment ID: I20201222000815 |
| Provider Name | Charlene Busman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275841413 PECOS PAC ID: 8628247855 Enrollment ID: I20210127001273 |
| Provider Name | Phillip S Ragland |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1912145707 PECOS PAC ID: 9032246921 Enrollment ID: I20210209000531 |
| Provider Name | Gregory Ross |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669516118 PECOS PAC ID: 0749690717 Enrollment ID: I20210510000859 |
| Provider Name | Asong Benanzea Fontem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578105326 PECOS PAC ID: 2567899024 Enrollment ID: I20210616000938 |
| Provider Name | Adeniran Adeleye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235779612 PECOS PAC ID: 9638581135 Enrollment ID: I20220825000061 |
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