| |
1900 E Northern Pkwy Ste 208 Baltimore MD 21239-2110 | |
(410) 864-1800 | |
(410) 864-1717 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1900 E Northern Pkwy Ste 208, Baltimore, Maryland |
Authorized Official Name and Position | Vivian N Uzoma (FAMILY NURSE PRACTITIONER) |
Authorized Official Contact | 4108641800 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1900 E Northern Pkwy Ste 208 Baltimore MD 21239-2110 Ph: (443) 570-3825 | 1900 E Northern Pkwy Ste 208 Baltimore MD 21239-2110 Ph: (410) 864-1800 |
NPI Number | 1891486551 |
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Provider Enumeration Date | 05/15/2023 |
Last Update Date | 09/12/2024 |
Medicare PECOS PAC ID | 3375905151 |
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Medicare Enrollment ID | O20230810001524 |
Identifier | Type | State | Issuer |
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1891486551 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Vivian N Uzoma |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962041855 PECOS PAC ID: 9830525401 Enrollment ID: I20200130002725 |
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