MEDICARE: OPTIMIZE MEDICAL 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	363LA2200X	Adult Health Nurse Practitioner	R179125	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952818999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMIZE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 72098
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-8098
Country	:	US
Telephone Number	:	443-868-7101
Fax Number	:	443-868-7956

Provider Business Practice Location Address
First Line	:	1314 BEDFORD AVE STE 113
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-3737
Country	:	US
Telephone Number	:	443-868-7101
Fax Number	:	443-868-7956

Authorized Official
Title or Position	:	OWNER/SOLE MEMBER
Name	:	JOHN KAMAU NGUGI
Credential	:	CRNP-C
Telephone Number	:	443-248-1929

Provider Enumeration Date	:	12/29/2017
Last Update Date	:	09/16/2022

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