| |
6830 Hospital Dr Suite 106 Baltimore MD 21237-4373 | |
(410) 284-3322 | |
(410) 284-7204 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6830 Hospital Dr, Baltimore, Maryland |
Authorized Official Name and Position | Kiumarce Kashi (PRESIDENT) |
Authorized Official Contact | 4102843322 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6830 Hospital Drive Suite 106 Baltimore MD 21237 Ph: (410) 284-3322 | 6830 Hospital Dr Suite 106 Baltimore MD 21237-4373 Ph: (410) 284-3322 |
NPI Number | 1063664217 |
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Provider Enumeration Date | 10/21/2008 |
Last Update Date | 08/14/2012 |
Medicare PECOS PAC ID | 6103984539 |
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Medicare Enrollment ID | O20081029000029 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063664217 | NPI | - | NPPES |
372481600 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | D0047658 (Maryland) | Primary |
Provider Name | Kiumarce Kashi |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1629081500 PECOS PAC ID: 8022059872 Enrollment ID: I20050521000083 |
Provider Name | Marni S Miltner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396126371 PECOS PAC ID: 8426358011 Enrollment ID: I20180418001939 |
Provider Name | Maria Lodia Lacson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447805098 PECOS PAC ID: 8325379324 Enrollment ID: I20191004002369 |
Provider Name | Sara Khaver |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396300158 PECOS PAC ID: 4981935897 Enrollment ID: I20191008000558 |
Provider Name | Christine C Grap |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609425453 PECOS PAC ID: 2264867647 Enrollment ID: I20200113000731 |
Provider Name | Melissa D Hunter |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104570035 PECOS PAC ID: 7810377116 Enrollment ID: I20220705000865 |
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