| 1st Medical Of Annapolis, Inc. | |
|
20 Mayo Rd Ste 201 Edgewater MD 21037-1442 | |
| (410) 956-6800 | |
| (410) 956-6803 |
| Full Name | 1st Medical Of Annapolis, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 20 Mayo Rd Ste 201, Edgewater, Maryland |
| Authorized Official Name and Position | Rosemary Ingado (CLINICAL ADMINISTRATOR/PHYSICIAN AS) |
| Authorized Official Contact | 4109566800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1st Medical Of Annapolis, Inc. 20 Mayo Rd Suite 201 Edgewater MD 21037-1439 Ph: (410) 956-6800 | 1st Medical Of Annapolis, Inc. 20 Mayo Rd Ste 201 Edgewater MD 21037-1442 Ph: (410) 956-6800 |
| NPI Number | 1922282425 |
|---|---|
| Provider Enumeration Date | 12/20/2007 |
| Last Update Date | 01/23/2022 |
| Medicare PECOS PAC ID | 6406754738 |
|---|---|
| Medicare Enrollment ID | O20031223000759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922282425 | NPI | - | NPPES |
| 516301300 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Nancy D Rivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295791309 PECOS PAC ID: 9739159799 Enrollment ID: I20061011000124 |
| Provider Name | Ann Marie Rustia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992039622 PECOS PAC ID: 9436325719 Enrollment ID: I20120109000610 |
| Provider Name | Adeola Olotu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467890855 PECOS PAC ID: 7113159591 Enrollment ID: I20140417001230 |
| Provider Name | Jacquelyn M Paylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952795544 PECOS PAC ID: 9133448806 Enrollment ID: I20150430000814 |
| Provider Name | Bolaji O Olugboja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689005043 PECOS PAC ID: 2860793460 Enrollment ID: I20151228001255 |
| Provider Name | Caroline Shirima |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114396637 PECOS PAC ID: 4284938911 Enrollment ID: I20160201002011 |
| Provider Name | Barbara Denkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427280601 PECOS PAC ID: 4880817923 Enrollment ID: I20161017001917 |
| Provider Name | Melissa Bassett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841732047 PECOS PAC ID: 4082995246 Enrollment ID: I20161229001429 |
| Provider Name | Perpetua Anthony |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083142442 PECOS PAC ID: 2466712310 Enrollment ID: I20180214001035 |
| Provider Name | Nancy Nyakundi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598134918 PECOS PAC ID: 7416243118 Enrollment ID: I20190320003062 |
| Provider Name | Irene Ginczek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083228357 PECOS PAC ID: 5092101972 Enrollment ID: I20230703000056 |
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