Healthcare Provider Details

I. General information

NPI: 1003384678
Provider Name (Legal Business Name): PRIME CLINICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9649 BELAIR ROAD SUITE 202
BALTIMORE MD
21236-1116
US

IV. Provider business mailing address

9649 BELAIR ROAD SUITE 202
BALTIMORE MD
21236-1116
US

V. Phone/Fax

Practice location:
  • Phone: 410-237-6904
  • Fax: 410-237-6912
Mailing address:
  • Phone: 410-237-6904
  • Fax: 410-237-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAUNTE F HARRIS
Title or Position: OWNER
Credential: PHARMD
Phone: 443-847-6822