| Mercy Health Pathway Llc | |
|
1509 Fitzpatrick Dr Severn MD 21144-3142 | |
| (301) 728-0345 | |
| Not Available |
| Full Name | Mercy Health Pathway Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1509 Fitzpatrick Dr, Severn, Maryland |
| Authorized Official Name and Position | Olatunji Iberu-olushoga (OWNER) |
| Authorized Official Contact | 3017280345 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Health Pathway Llc 1509 Fitzpatrick Dr Severn MD 21144-3142 Ph: (301) 728-0345 | Mercy Health Pathway Llc 1509 Fitzpatrick Dr Severn MD 21144-3142 Ph: (301) 728-0345 |
| NPI Number | 1942993019 |
|---|---|
| Provider Enumeration Date | 06/02/2023 |
| Last Update Date | 06/02/2023 |
| Medicare PECOS PAC ID | 3870957186 |
|---|---|
| Medicare Enrollment ID | O20230919002887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942993019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Olatunji I Iberu-olushoga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104497841 PECOS PAC ID: 6507255155 Enrollment ID: I20220217001814 |
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