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3425 Sinclair Ln Baltimore MD 21213-2030 | |
| (410) 366-1151 | |
| (410) 366-0035 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3425 Sinclair Ln, Baltimore, Maryland |
| Authorized Official Name and Position | Charmaine Nalty (PRESIDENT) |
| Authorized Official Contact | 4103661151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3425 Sinclair Ln Baltimore MD 21213-2030 Ph: (410) 366-1151 | 3425 Sinclair Ln Baltimore MD 21213-2030 Ph: (410) 366-1151 |
| NPI Number | 1265486740 |
|---|---|
| Provider Enumeration Date | 05/20/2006 |
| Last Update Date | 02/06/2017 |
| Medicare PECOS PAC ID | 1658435375 |
|---|---|
| Medicare Enrollment ID | O20150224001281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265486740 | NPI | - | NPPES |
| 407640100 | Medicaid | MD |
| Provider Name | Tyrone D Fillyaw |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124285093 PECOS PAC ID: 9133113285 Enrollment ID: I20040412001109 |
| Provider Name | Oluwatoyin C Adisa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013156181 PECOS PAC ID: 0840326088 Enrollment ID: I20111103000407 |
| Provider Name | Nkem Zos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811317472 PECOS PAC ID: 4183849730 Enrollment ID: I20140715002143 |
| Provider Name | Lera Ison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952787400 PECOS PAC ID: 2567766165 Enrollment ID: I20160202000972 |
| Provider Name | Timothy Udoji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629547138 PECOS PAC ID: 4981937554 Enrollment ID: I20190613001448 |
| Provider Name | Eric Angeme Amene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750641221 PECOS PAC ID: 9830424209 Enrollment ID: I20190709000609 |
| Provider Name | Olufunke A Taiwo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861058570 PECOS PAC ID: 2860829561 Enrollment ID: I20200218002827 |
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