| Ethos Health Maryland 1 Llc | |
|
4940 Campbell Blvd Ste 130 Nottingham MD 21236-5910 | |
| (410) 870-6498 | |
| (410) 870-6555 |
| Full Name | Ethos Health Maryland 1 Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4940 Campbell Blvd Ste 130, Nottingham, Maryland |
| Authorized Official Name and Position | Jonathan Ray Walker (OWNER) |
| Authorized Official Contact | 3527325590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethos Health Maryland 1 Llc 1541 Se 17th St Ocala FL 34471-4607 Ph: (352) 732-5590 | Ethos Health Maryland 1 Llc 4940 Campbell Blvd Ste 130 Nottingham MD 21236-5910 Ph: (410) 870-6498 |
| NPI Number | 1144888025 |
|---|---|
| Provider Enumeration Date | 06/05/2019 |
| Last Update Date | 03/03/2021 |
| Medicare PECOS PAC ID | 6608102041 |
|---|---|
| Medicare Enrollment ID | O20190724000086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144888025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Raena K Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861709081 PECOS PAC ID: 6901084680 Enrollment ID: I20110628000578 |
| Provider Name | Vicki L Goldberg |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1609207083 PECOS PAC ID: 6204068406 Enrollment ID: I20140422000273 |
| Provider Name | Zachary Thomas Kramer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477084200 PECOS PAC ID: 1850659111 Enrollment ID: I20171215000215 |
| Provider Name | Debrahe Rowland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023556321 PECOS PAC ID: 5496014060 Enrollment ID: I20180108000531 |
| Provider Name | Daisuke Matsuo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992290951 PECOS PAC ID: 3476801515 Enrollment ID: I20180806001276 |
| Provider Name | Nacresha Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891259925 PECOS PAC ID: 9739415191 Enrollment ID: I20190724000764 |
| Provider Name | Kerry Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366094260 PECOS PAC ID: 8022348358 Enrollment ID: I20190930000113 |
| Provider Name | Irina Konstantinovna Baum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093354920 PECOS PAC ID: 2163851965 Enrollment ID: I20200330003024 |
| Provider Name | Kelly Getz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700481769 PECOS PAC ID: 4486067303 Enrollment ID: I20210113001251 |
| Provider Name | Lanaya Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407468887 PECOS PAC ID: 8325455777 Enrollment ID: I20210331000763 |
| Provider Name | Jennifer Rogofsky |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154651842 PECOS PAC ID: 9739586223 Enrollment ID: I20210927001165 |
| Provider Name | Lauremnesal Catre Gamolo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174290258 PECOS PAC ID: 3072911403 Enrollment ID: I20211014002473 |
Jeffrey C. Schultz, M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8817 Belair Rd, Suite 111, Nottingham, MD 21236 Phone: 410-529-6440 Fax: 410-529-6793 | |
Port Recovery Physicians Care Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236 Phone: 443-869-4909 Fax: 443-869-4928 | |
Sofia Suriel Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8870 Belair Rd, Nottingham, MD 21236 Phone: 410-248-3124 Fax: 410-248-3125 | |
Lifegate Global Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5430 Campbell Blvd, Ste 208, Nottingham, MD 21236 Phone: 443-823-5066 | |
Maryland Medical Center, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8100 Sandpiper Cir Ste 100, Nottingham, MD 21236 Phone: 410-529-8334 | |
Breakthrough Integrative Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9712 Belair Rd Ste 301, Nottingham, MD 21236 Phone: 443-903-4874 Fax: 667-868-0931 |