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6314 Windsor Mill Rd Ste 201 Baltimore MD 21207-6095 | |
(443) 780-4439 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 6314 Windsor Mill Rd Ste 201, Baltimore, Maryland |
Authorized Official Name and Position | Mujahid Muhammad (CEO) |
Authorized Official Contact | 4438043543 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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822 Guilford Ave # 209 Baltimore MD 21202-3707 Ph: () - | 6314 Windsor Mill Rd Ste 201 Baltimore MD 21207-6095 Ph: (443) 780-4439 |
NPI Number | 1548946296 |
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Provider Enumeration Date | 06/27/2023 |
Last Update Date | 04/24/2024 |
Medicare PECOS PAC ID | 4183167414 |
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Medicare Enrollment ID | O20240614002809 |
Identifier | Type | State | Issuer |
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1548946296 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Adetounse Ademiluyi |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669889614 PECOS PAC ID: 9335589951 Enrollment ID: I20240430003019 |
Provider Name | Adekemi Akinyemi |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548737299 PECOS PAC ID: 5496298747 Enrollment ID: I20240614003392 |
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