Healthcare Provider Details

I. General information

NPI: 1215847082
Provider Name (Legal Business Name): EMERALD MAT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E LEXINGTON ST
BALTIMORE MD
21202-3501
US

IV. Provider business mailing address

214 E LEXINGTON ST
BALTIMORE MD
21202-3501
US

V. Phone/Fax

Practice location:
  • Phone: 410-801-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: OLUWAKEMI OGUNSEYE
Title or Position: PRINCIPAL
Credential:
Phone: 301-254-3524