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46499 Porto Bello Ct Drayden MD 20630-3217 | |
(801) 920-5561 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 46499 Porto Bello Ct, Drayden, Maryland |
Authorized Official Name and Position | Sheri Dean (OWNER/PROVIDER) |
Authorized Official Contact | 8019205561 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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46499 Porto Bello Ct Drayden MD 20630-3217 Ph: (801) 920-5561 | 46499 Porto Bello Ct Drayden MD 20630-3217 Ph: (801) 920-5561 |
NPI Number | 1174307656 |
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Provider Enumeration Date | 08/24/2023 |
Last Update Date | 09/19/2023 |
Medicare PECOS PAC ID | 8820444797 |
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Medicare Enrollment ID | O20231029000060 |
Identifier | Type | State | Issuer |
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1174307656 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Sheri Dean |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245770189 PECOS PAC ID: 8426197930 Enrollment ID: I20170925002041 |