Healthcare Provider Details

I. General information

NPI: 1164094371
Provider Name (Legal Business Name): LEXINGTON PRIMARY CARE LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E LEXINGTON ST STE 600
BALTIMORE MD
21202-1711
US

IV. Provider business mailing address

11 E LEXINGTON ST STE 600
BALTIMORE MD
21202-1711
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-5612
  • Fax:
Mailing address:
  • Phone: 443-708-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BISRAT MESFIN
Title or Position: CEO
Credential: PMHNP, FNP
Phone: 443-708-5612