| Premier Medical Group Of Maryland Llc | |
|
10705 Charter Dr Ste 420 Columbia MD 21044-2800 | |
| (410) 709-7432 | |
| Not Available |
| Full Name | Premier Medical Group Of Maryland Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10705 Charter Dr Ste 420, Columbia, Maryland |
| Authorized Official Name and Position | Mary Fakorede (MD) |
| Authorized Official Contact | 4107097432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical Group Of Maryland Llc 10705 Charter Dr Ste 420 Columbia MD 21044-2800 Ph: (410) 709-7432 | Premier Medical Group Of Maryland Llc 10705 Charter Dr Ste 420 Columbia MD 21044-2800 Ph: (410) 709-7432 |
| NPI Number | 1023791605 |
|---|---|
| Provider Enumeration Date | 08/09/2023 |
| Last Update Date | 08/09/2023 |
| Medicare PECOS PAC ID | 8123482635 |
|---|---|
| Medicare Enrollment ID | O20230918001953 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023791605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mary Fakorede |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922569714 PECOS PAC ID: 8123405693 Enrollment ID: I20220809003394 |
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