MEDICARE: PRIMAL POINT LLC

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	363LF0000X	Family Nurse Practitioner
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1568231298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMAL POINT LLC

Provider Business Mailing Address
First Line	:	9001 HARFORD RD
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-4029
Country	:	US
Telephone Number	:	410-870-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 HARFORD RD
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-4029
Country	:	US
Telephone Number	:	410-870-1590
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NGUFOR FUBE DIVINE
Credential	:
Telephone Number	:	240-423-8757

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	06/04/2026

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Directions to “PRIMAL POINT LLC ” Practice Location

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