| Elite Weightloss & Trt | |
|
1604 Ridgeside Dr Ste B2 Mount Airy MD 21771-5240 | |
| (410) 498-7055 | |
| Not Available |
| Full Name | Elite Weightloss & Trt |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1604 Ridgeside Dr Ste B2, Mount Airy, Maryland |
| Authorized Official Name and Position | Emilienne Nkemayim (OWNER) |
| Authorized Official Contact | 4104987055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Weightloss & Trt 1604 Ridgeside Dr Ste B2 Mount Airy MD 21771-5240 Ph: (410) 498-7055 | Elite Weightloss & Trt 1604 Ridgeside Dr Ste B2 Mount Airy MD 21771-5240 Ph: (410) 498-7055 |
| NPI Number | 1568283547 |
|---|---|
| Provider Enumeration Date | 10/22/2024 |
| Last Update Date | 03/06/2025 |
| Medicare PECOS PAC ID | 2567999642 |
|---|---|
| Medicare Enrollment ID | O20241231003275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568283547 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
| Provider Name | Emilienne Nguatem Nkemayim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093224149 PECOS PAC ID: 0648546200 Enrollment ID: I20171026000029 |
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