Healthcare Provider Details

I. General information

NPI: 1922634534
Provider Name (Legal Business Name): PROGRESSIVE MULTI MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PHILADELPHIA BLVD STE A
ABERDEEN MD
21001-2568
US

IV. Provider business mailing address

1803 PENN AVE
BALTIMORE MD
21217-3235
US

V. Phone/Fax

Practice location:
  • Phone: 443-530-3182
  • Fax: 443-399-8223
Mailing address:
  • Phone: 443-931-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOY OKWUCHI UWANDU
Title or Position: PRESIDENT
Credential: CRNP/FNP-C
Phone: 443-530-3182