Devine Family Care Practice Llc | |
7131 Liberty Rd Ste 100 Gwynn Oak MD 21207-4580 | |
(410) 963-9577 | |
(443) 200-5261 |
Full Name | Devine Family Care Practice Llc |
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Speciality | Family Medicine |
Location | 7131 Liberty Rd Ste 100, Gwynn Oak, Maryland |
Authorized Official Name and Position | Stella Mbah (CMO/OWNER) |
Authorized Official Contact | 4109639577 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Devine Family Care Practice Llc 7131 Liberty Rd Ste 100 Gwynn Oak MD 21207-4580 Ph: (410) 963-9577 | Devine Family Care Practice Llc 7131 Liberty Rd Ste 100 Gwynn Oak MD 21207-4580 Ph: (410) 963-9577 |
NPI Number | 1053828244 |
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Provider Enumeration Date | 01/09/2018 |
Last Update Date | 06/28/2023 |
Medicare PECOS PAC ID | 4981969961 |
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Medicare Enrollment ID | O20180522000533 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053828244 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Stella Ebere Mbah |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851787725 PECOS PAC ID: 7911219282 Enrollment ID: I20150630001755 |
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