Healthcare Provider Details

I. General information

NPI: 1043859622
Provider Name (Legal Business Name): MOMENTUM HEALTH CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 BELAIR RD
BALTIMORE MD
21206-3654
US

IV. Provider business mailing address

5525 BELAIR RD
BALTIMORE MD
21206-3654
US

V. Phone/Fax

Practice location:
  • Phone: 443-831-0617
  • Fax:
Mailing address:
  • Phone: 443-831-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA POTERE
Title or Position: ADMINISTRATOR
Credential: MBA, CHCQM
Phone: 954-695-6847