Healthcare Provider Details

I. General information

NPI: 1346910130
Provider Name (Legal Business Name): BEYOND PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE E202
CLINTON MD
20735-1609
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE E202
CLINTON MD
20735-1609
US

V. Phone/Fax

Practice location:
  • Phone: 240-412-5093
  • Fax:
Mailing address:
  • Phone: 240-412-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHERISE HAGANS
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 240-412-5093