| Summit Medical Group Llc | |
|
6310 Stevens Forest Rd Ste 200 Columbia MD 21046-1068 | |
| (410) 740-9001 | |
| (410) 740-9005 |
| Full Name | Summit Medical Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6310 Stevens Forest Rd Ste 200, Columbia, Maryland |
| Authorized Official Name and Position | Njideka Udochi (OWNER) |
| Authorized Official Contact | 4102452414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Medical Group Llc 14520 Edgewoods Way Glenelg MD 21737-9608 Ph: (410) 245-2414 | Summit Medical Group Llc 6310 Stevens Forest Rd Ste 200 Columbia MD 21046-1068 Ph: (410) 740-9001 |
| NPI Number | 1952970816 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 12/13/2023 |
| Medicare PECOS PAC ID | 6507252806 |
|---|---|
| Medicare Enrollment ID | O20220414000801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952970816 | NPI | - | NPPES |
| D00051897 | Other | MD | MD LICENSE |
| 685900301 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Michael C Obiefune |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073552881 PECOS PAC ID: 7012994130 Enrollment ID: I20040706001273 |
| Provider Name | Njideka E Udochi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952580821 PECOS PAC ID: 9234100215 Enrollment ID: I20040803001469 |
| Provider Name | Anthea E Nwandu |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1609861459 PECOS PAC ID: 1254391105 Enrollment ID: I20041014000678 |
| Provider Name | Joy Chyddy Umeobi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346832649 PECOS PAC ID: 1850794546 Enrollment ID: I20210823002179 |
| Provider Name | Oluwadamilola Akinsola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326554809 PECOS PAC ID: 5294121448 Enrollment ID: I20220415000431 |
| Provider Name | Shawna Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437488103 PECOS PAC ID: 2062808215 Enrollment ID: I20220415000588 |
| Provider Name | Chichi Udochi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477016517 PECOS PAC ID: 0648506436 Enrollment ID: I20220914000184 |
| Provider Name | Timsy Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992411094 PECOS PAC ID: 7416317508 Enrollment ID: I20230721000187 |
| Provider Name | Betrand A Ekenja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790163830 PECOS PAC ID: 5294197885 Enrollment ID: I20230814003016 |
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