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6340 Security Blvd Ste 100b40 Baltimore MD 21207-5173 | |
| (443) 791-7005 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6340 Security Blvd Ste 100b40, Baltimore, Maryland |
| Authorized Official Name and Position | Mathias Bama (CEO) |
| Authorized Official Contact | 4437917005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6340 Security Blvd Ste 100b40 Baltimore MD 21207-5173 Ph: () - | 6340 Security Blvd Ste 100b40 Baltimore MD 21207-5173 Ph: (443) 791-7005 |
| NPI Number | 1285473991 |
|---|---|
| Provider Enumeration Date | 05/22/2024 |
| Last Update Date | 08/15/2024 |
| Certification Date | 08/15/2024 |
| Medicare PECOS PAC ID | 7618402496 |
|---|---|
| Medicare Enrollment ID | O20241203002858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285473991 | NPI | - | NPPES |
| Provider Name | Leopoldine Tchakouteu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255050019 PECOS PAC ID: 5698114262 Enrollment ID: I20240415004117 |
| Provider Name | Juliet Lum Numfor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205554359 PECOS PAC ID: 6901348127 Enrollment ID: I20240604000154 |
| Provider Name | Godwina Pamela Odigie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447937792 PECOS PAC ID: 8729520812 Enrollment ID: I20240604003109 |
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