Healthcare Provider Details

I. General information

NPI: 1760250922
Provider Name (Legal Business Name): POIMANO HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 CHARTER DR STE 420
COLUMBIA MD
21044-2800
US

IV. Provider business mailing address

7266 STALLINGS DR
GLEN BURNIE MD
21060-8370
US

V. Phone/Fax

Practice location:
  • Phone: 443-219-6511
  • Fax:
Mailing address:
  • Phone: 443-219-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYLVANUS BRENYA MENSAH
Title or Position: PRESIDENT
Credential: DNP, AGNP
Phone: 443-219-6511