| Pmms | |
|
200 N Philadelphia Blvd Ste A Aberdeen MD 21001-2568 | |
| (443) 530-3182 | |
| (443) 399-8223 |
| Full Name | Pmms |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 N Philadelphia Blvd Ste A, Aberdeen, Maryland |
| Authorized Official Name and Position | Joy Okwuchi Uwandu (PRESIDENT) |
| Authorized Official Contact | 4435303182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmms 1803 Penn Ave Baltimore MD 21217-3235 Ph: (443) 931-5352 | Pmms 200 N Philadelphia Blvd Ste A Aberdeen MD 21001-2568 Ph: (443) 530-3182 |
| NPI Number | 1922634534 |
|---|---|
| Provider Enumeration Date | 03/14/2020 |
| Last Update Date | 01/07/2021 |
| Medicare PECOS PAC ID | 5991124687 |
|---|---|
| Medicare Enrollment ID | O20200930000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922634534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Kenneth C Eguzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518511054 PECOS PAC ID: 4385073097 Enrollment ID: I20200401000597 |
| Provider Name | Joy Okwuchi Uwandu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528531498 PECOS PAC ID: 6800215591 Enrollment ID: I20200930000036 |
| Provider Name | Lacreasha A Fullard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821696196 PECOS PAC ID: 6608267026 Enrollment ID: I20211220000885 |
| Provider Name | Kumba Baryoh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902552904 PECOS PAC ID: 1850770611 Enrollment ID: I20220624001096 |
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