Healthcare Provider Details

I. General information

NPI: 1851272488
Provider Name (Legal Business Name): GOODTIME FAMILY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 MORAVIA RD
BALTIMORE MD
21206-6133
US

IV. Provider business mailing address

7131 LIBERTY RD STE 103
GWYNN OAK MD
21207-4580
US

V. Phone/Fax

Practice location:
  • Phone: 410-325-5700
  • Fax:
Mailing address:
  • Phone: 410-325-5700
  • Fax: 410-325-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH-VENATIUS I OSUAGWU
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 410-325-5700