Healthcare Provider Details

I. General information

NPI: 1083142780
Provider Name (Legal Business Name): CITYCARE FAMILY PRACTICE & URGENT CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GATEWAY DR STE 17-18B
BEL AIR MD
21014-4268
US

IV. Provider business mailing address

260 GATEWAY DR STE 17-18B
BEL AIR MD
21014-4268
US

V. Phone/Fax

Practice location:
  • Phone: 443-787-4228
  • Fax: 443-787-4263
Mailing address:
  • Phone: 443-787-4228
  • Fax: 443-787-4263

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 Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLADIMEJI ADEDIRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-383-9976