| Gennesaret Medical Center, Llc | |
|
13992 Baltimore Ave Ste 200 Laurel MD 20707-5010 | |
| (410) 528-6003 | |
| (410) 528-6004 |
| Full Name | Gennesaret Medical Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13992 Baltimore Ave Ste 200, Laurel, Maryland |
| Authorized Official Name and Position | Toyin Opesanmi (PHYSICIAN) |
| Authorized Official Contact | 4109635870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gennesaret Medical Center, Llc 12108 Early Lilacs Path Clarksville MD 21029-1676 Ph: (410) 963-5870 | Gennesaret Medical Center, Llc 13992 Baltimore Ave Ste 200 Laurel MD 20707-5010 Ph: (410) 528-6003 |
| NPI Number | 1588962245 |
|---|---|
| Provider Enumeration Date | 03/04/2011 |
| Last Update Date | 05/17/2019 |
| Medicare PECOS PAC ID | 0749468767 |
|---|---|
| Medicare Enrollment ID | O20110622000314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588962245 | NPI | - | NPPES |
| 000911300 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D0059876 (Maryland) | Primary |
| Provider Name | Toyin O Opesanmi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346332434 PECOS PAC ID: 9133119829 Enrollment ID: I20110624000231 |
| Provider Name | Promise Allan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215584271 PECOS PAC ID: 6002229762 Enrollment ID: I20210119002674 |
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