| Md002a | |
|
621 Ridgely Ave Ste 201 Annapolis MD 21401-1083 | |
| (410) 224-4887 | |
| (410) 224-1428 |
| Full Name | Md002a |
|---|---|
| Speciality | Internal Medicine |
| Location | 621 Ridgely Ave Ste 201, Annapolis, Maryland |
| Authorized Official Name and Position | Alan Oliver (CEO) |
| Authorized Official Contact | 7865303820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Md002a 621 Ridgely Ave Ste 201 Annapolis MD 21401-1083 Ph: (410) 224-4887 | Md002a 621 Ridgely Ave Ste 201 Annapolis MD 21401-1083 Ph: (410) 224-4887 |
| NPI Number | 1023765625 |
|---|---|
| Provider Enumeration Date | 03/04/2022 |
| Last Update Date | 07/29/2024 |
| Medicare PECOS PAC ID | 5597151357 |
|---|---|
| Medicare Enrollment ID | O20220404000398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023765625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Danielle R Boggio |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1194721712 PECOS PAC ID: 6002808953 Enrollment ID: I20040331001194 |
| Provider Name | Aminur R Khan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1114009263 PECOS PAC ID: 9133033459 Enrollment ID: I20040414001206 |
| Provider Name | Andrew H Rosenstein |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1275615486 PECOS PAC ID: 8325952641 Enrollment ID: I20040414001370 |
| Provider Name | Michael Epstein |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1942238928 PECOS PAC ID: 9830186683 Enrollment ID: I20040426001271 |
| Provider Name | Charles E King |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1558399436 PECOS PAC ID: 7719976778 Enrollment ID: I20040506001232 |
| Provider Name | Kester I.h. Crosse |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1063411908 PECOS PAC ID: 6608857925 Enrollment ID: I20040525000117 |
| Provider Name | Michael S Ballo |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1780648550 PECOS PAC ID: 2163498239 Enrollment ID: I20040909000625 |
| Provider Name | Thomas W Abernathy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1538105697 PECOS PAC ID: 6800820481 Enrollment ID: I20050922000972 |
| Provider Name | Preston Y Kim |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1194715391 PECOS PAC ID: 3173540051 Enrollment ID: I20051031000160 |
| Provider Name | Mary K Browning |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689683245 PECOS PAC ID: 6204889090 Enrollment ID: I20060105000671 |
| Provider Name | Enrico A Giangeruso |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1568560134 PECOS PAC ID: 8527005180 Enrollment ID: I20061212000231 |
| Provider Name | Allen Tibagaywa Banegura |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1780895854 PECOS PAC ID: 6901998392 Enrollment ID: I20070815000123 |
| Provider Name | Joshua S Forman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093801763 PECOS PAC ID: 7012084379 Enrollment ID: I20080929000300 |
| Provider Name | Barry J Cukor |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316115595 PECOS PAC ID: 0547235558 Enrollment ID: I20090729000798 |
| Provider Name | Vishnupriya Krishna |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902822299 PECOS PAC ID: 7315941051 Enrollment ID: I20091015000049 |
| Provider Name | Louis Salas |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1164420154 PECOS PAC ID: 7517019631 Enrollment ID: I20100128000409 |
| Provider Name | Natarajan Ravendhran |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1821071069 PECOS PAC ID: 6406913219 Enrollment ID: I20100128000432 |
| Provider Name | Christopher Y Kim |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1922006931 PECOS PAC ID: 9436201555 Enrollment ID: I20100128000450 |
| Provider Name | Richard I Andorsky |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1295733558 PECOS PAC ID: 5890847917 Enrollment ID: I20100128000529 |
| Provider Name | Emilene S Drager |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1912188095 PECOS PAC ID: 5496898223 Enrollment ID: I20100202000705 |
| Provider Name | Kevin Wolov |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1770799447 PECOS PAC ID: 7810027794 Enrollment ID: I20100621000291 |
| Provider Name | Alana Robyn Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891026266 PECOS PAC ID: 1658567631 Enrollment ID: I20101202000645 |
| Provider Name | Tricia C Carvalho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043533508 PECOS PAC ID: 8820279755 Enrollment ID: I20110224000504 |
| Provider Name | Krystle S Thomas |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1629379334 PECOS PAC ID: 1951584333 Enrollment ID: I20110322000868 |
| Provider Name | Brian J Plasil |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164638151 PECOS PAC ID: 7113056078 Enrollment ID: I20111003000476 |
| Provider Name | Shazeeda Averitt |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1588686612 PECOS PAC ID: 9830234434 Enrollment ID: I20120319000512 |
| Provider Name | Christina Fang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003179805 PECOS PAC ID: 8820254717 Enrollment ID: I20120720000402 |
| Provider Name | Ernestine A Kaloko |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1427389774 PECOS PAC ID: 2668508953 Enrollment ID: I20121206000427 |
| Provider Name | Biju K Alex |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1750558342 PECOS PAC ID: 8628219557 Enrollment ID: I20130723000228 |
| Provider Name | Jamie B Walters |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093966897 PECOS PAC ID: 4688817604 Enrollment ID: I20130823000475 |
| Provider Name | Jeffrey Van Den Broek |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1033180187 PECOS PAC ID: 8325103070 Enrollment ID: I20130909000023 |
| Provider Name | Adnan R Khan |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1942469770 PECOS PAC ID: 1254574429 Enrollment ID: I20130909000275 |
| Provider Name | Neeraj Sardana |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1679783021 PECOS PAC ID: 2860538121 Enrollment ID: I20130910000031 |
| Provider Name | Grishma Joy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1336239656 PECOS PAC ID: 8527253632 Enrollment ID: I20140909001709 |
| Provider Name | Tara A Powers |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1629312608 PECOS PAC ID: 2163667924 Enrollment ID: I20151007000339 |
| Provider Name | Missale Solomon |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1245492693 PECOS PAC ID: 2466600010 Enrollment ID: I20160620001024 |
| Provider Name | Nathalie Orr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417316357 PECOS PAC ID: 0840581278 Enrollment ID: I20160621000427 |
| Provider Name | Grace Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245782010 PECOS PAC ID: 9436435377 Enrollment ID: I20170407001910 |
| Provider Name | Brittany E Dickert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598165474 PECOS PAC ID: 5991081515 Enrollment ID: I20170417000290 |
| Provider Name | Ghita Moussaide |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649535667 PECOS PAC ID: 3274813266 Enrollment ID: I20180904001779 |
| Provider Name | Mary Grace Renfrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801372800 PECOS PAC ID: 2163773557 Enrollment ID: I20180925000391 |
| Provider Name | Crystal Olivia Leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265908446 PECOS PAC ID: 0941545818 Enrollment ID: I20181220002387 |
| Provider Name | Carl C Gable |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1942416011 PECOS PAC ID: 3779657556 Enrollment ID: I20190426001672 |
| Provider Name | Robin Korin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063895118 PECOS PAC ID: 9133436355 Enrollment ID: I20200826002196 |
| Provider Name | Abby T Weinrub |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295109809 PECOS PAC ID: 5890099519 Enrollment ID: I20201104000584 |
| Provider Name | Shadi Razmdjou |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1154703585 PECOS PAC ID: 4082962170 Enrollment ID: I20211007000057 |
| Provider Name | Mary Theresa Fanning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194219097 PECOS PAC ID: 2062768310 Enrollment ID: I20220202002962 |
| Provider Name | Samantha Butzke |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780114967 PECOS PAC ID: 0840674032 Enrollment ID: I20220907003524 |
Mdics Rehabilitative Services Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 900 Van Buren St, Annapolis, MD 21403 Phone: 410-267-8653 | |
Luminis Health Primary Care Ginger Cove Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4000 River Crescent Dr, Annapolis, MD 21401 Phone: 443-481-1000 | |
Premier Mri Services Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 Ridgley Ave, Suite 12, Annapolis, MD 21401 Phone: 410-267-1780 Fax: 410-267-1784 | |
Annapolis Psychological Services, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 512 State St, Annapolis, MD 21403 Phone: 667-401-7710 | |
Dr. Nancy's Housecalls Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1209a Marda Ln, Annapolis, MD 21403 Phone: 410-353-9323 Fax: 410-741-3870 | |
Jack R Lichtenstein, Md Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 Ridgely Ave, Annapolis, MD 21401 Phone: 410-263-6910 Fax: 443-433-0456 |