MEDICARE: EVON MEDICS TMS GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1386399921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVON MEDICS TMS GROUP

Provider Business Mailing Address
First Line	:	11053 HUNTERS VIEW RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6100
Country	:	US
Telephone Number	:	914-888-7678
Fax Number	:

Provider Business Practice Location Address
First Line	:	6021 UNIVERSITY BLVD STE 250-260
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6077
Country	:	US
Telephone Number	:	914-888-7678
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CHIEF OPERATING OFFICER
Name	:	CHARLES NWAOKOBIA
Credential	:
Telephone Number	:	914-888-7678

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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