| Ethos Health Maryland 3 Llc | |
|
10840 Little Patuxent Pkwy Columbia MD 21044-3115 | |
| (352) 732-5590 | |
| (352) 732-0292 |
| Full Name | Ethos Health Maryland 3 Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10840 Little Patuxent Pkwy, Columbia, Maryland |
| Authorized Official Name and Position | Jonathan 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 3 Llc 1541 Se 17th St Ocala FL 34471-4607 Ph: (352) 732-5590 | Ethos Health Maryland 3 Llc 10840 Little Patuxent Pkwy Columbia MD 21044-3115 Ph: (352) 732-5590 |
| NPI Number | 1003455627 |
|---|---|
| Provider Enumeration Date | 12/30/2019 |
| Last Update Date | 12/30/2019 |
| Medicare PECOS PAC ID | 9739515115 |
|---|---|
| Medicare Enrollment ID | O20200203001345 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003455627 | 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 | Debrahe Rowland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023556321 PECOS PAC ID: 5496014060 Enrollment ID: I20180108000531 |
| Provider Name | Ma Sarah C Remaneses |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033486352 PECOS PAC ID: 4789987637 Enrollment ID: I20180911003243 |
| Provider Name | Kerry Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366094260 PECOS PAC ID: 8022348358 Enrollment ID: I20190930000113 |
| Provider Name | Tamika Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699314393 PECOS PAC ID: 4880021336 Enrollment ID: I20200224001603 |
| Provider Name | Bishal Malla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801485768 PECOS PAC ID: 6406262377 Enrollment ID: I20210302000546 |
| Provider Name | Jennifer Rogofsky |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154651842 PECOS PAC ID: 9739586223 Enrollment ID: I20210927001165 |
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