| Advance Integrated Health, Llc | |
|
16204 Penterra Way Bowie MD 20716-1919 | |
| (301) 978-1990 | |
| Not Available |
| Full Name | Advance Integrated Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 16204 Penterra Way, Bowie, Maryland |
| Authorized Official Name and Position | Deborah Kesewah Koroma (NURSE PRACTITIONER) |
| Authorized Official Contact | 3019781990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advance Integrated Health, Llc 16204 Penterra Way Bowie MD 20716-1919 Ph: (301) 978-1990 | Advance Integrated Health, Llc 16204 Penterra Way Bowie MD 20716-1919 Ph: (301) 978-1990 |
| NPI Number | 1952934671 |
|---|---|
| Provider Enumeration Date | 02/20/2020 |
| Last Update Date | 02/20/2020 |
| Certification Date | 02/20/2020 |
| Medicare PECOS PAC ID | 4183043623 |
|---|---|
| Medicare Enrollment ID | O20201028002136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952934671 | NPI | - | NPPES |
| Provider Name | Samuel Sulaiman Koroma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790324960 PECOS PAC ID: 4981034931 Enrollment ID: I20201028002375 |
| Provider Name | Quinta Manenju |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629323464 PECOS PAC ID: 1052722865 Enrollment ID: I20201201000085 |
| Provider Name | Deborah Koroma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780982066 PECOS PAC ID: 1850707886 Enrollment ID: I20210317000238 |
| Provider Name | Titilayo Ajayi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720732423 PECOS PAC ID: 9830586148 Enrollment ID: I20220504002481 |
| Provider Name | Gertrude N Ndansi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043579998 PECOS PAC ID: 6406219435 Enrollment ID: I20230824000354 |
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