| Chmg Corelife, Llc | |
|
1036 Saint Nicholas Dr Unit 101 Waldorf MD 20603-4758 | |
| (240) 261-7170 | |
| Not Available |
| Full Name | Chmg Corelife, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1036 Saint Nicholas Dr Unit 101, Waldorf, Maryland |
| Authorized Official Name and Position | Carolyn Heithaus (CFO) |
| Authorized Official Contact | 4105358236 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chmg Corelife, Llc 1099 Winterson Rd Ste 300 Linthicum Heights MD 21090-2279 Ph: (800) 905-3261 | Chmg Corelife, Llc 1036 Saint Nicholas Dr Unit 101 Waldorf MD 20603-4758 Ph: (240) 261-7170 |
| NPI Number | 1629660147 |
|---|---|
| Provider Enumeration Date | 02/05/2021 |
| Last Update Date | 01/16/2024 |
| Certification Date | 01/16/2024 |
| Medicare PECOS PAC ID | 9133526841 |
|---|---|
| Medicare Enrollment ID | O20210923000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629660147 | NPI | - | NPPES |
| Provider Name | Brian R Baker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902942808 PECOS PAC ID: 6507966314 Enrollment ID: I20100921001195 |
| Provider Name | Leah Csw Mandley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306216049 PECOS PAC ID: 6901115583 Enrollment ID: I20151021002765 |
| Provider Name | Lori Economos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205970100 PECOS PAC ID: 8426395310 Enrollment ID: I20190131000418 |
| Provider Name | Sabrin S Kraziem |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1093372948 PECOS PAC ID: 1052645025 Enrollment ID: I20190625001722 |
| Provider Name | Lindsey Combs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225652233 PECOS PAC ID: 9032533187 Enrollment ID: I20200722000876 |
| Provider Name | Patrick Dunn |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1679964910 PECOS PAC ID: 6709294028 Enrollment ID: I20210426000986 |
| Provider Name | Kia Elliott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447733811 PECOS PAC ID: 3476953639 Enrollment ID: I20210610001126 |
| Provider Name | Carrie Ann Catalan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457963001 PECOS PAC ID: 3779980404 Enrollment ID: I20210923000992 |
| Provider Name | Miriam C Dyson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1558034330 PECOS PAC ID: 6800293531 Enrollment ID: I20210923001239 |
| Provider Name | Jessica Lynn Erisman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497413298 PECOS PAC ID: 4789077025 Enrollment ID: I20220208002689 |
| Provider Name | Amber Hamilton |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1669121190 PECOS PAC ID: 2668852195 Enrollment ID: I20220630000946 |
| Provider Name | Oloruntobi Agbelusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487888368 PECOS PAC ID: 5395162903 Enrollment ID: I20220707000679 |
| Provider Name | Carly Jane Waldman |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508586215 PECOS PAC ID: 3678958436 Enrollment ID: I20220914001595 |
| Provider Name | Rita A Eusanio |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1447866926 PECOS PAC ID: 8921482092 Enrollment ID: I20220926002050 |
| Provider Name | Avni Jain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982775417 PECOS PAC ID: 1254436157 Enrollment ID: I20221010000016 |
| Provider Name | Ashley Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750836979 PECOS PAC ID: 9234417338 Enrollment ID: I20221115000257 |
| Provider Name | Chelsi Lee Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982316311 PECOS PAC ID: 6305210741 Enrollment ID: I20230325000021 |
| Provider Name | Kelly M Green |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1013533728 PECOS PAC ID: 1850758863 Enrollment ID: I20230607000837 |
| Provider Name | Maddison E Little |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1003696246 PECOS PAC ID: 3678920832 Enrollment ID: I20231109000164 |
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