Healthcare Provider Details

I. General information

NPI: 1235771148
Provider Name (Legal Business Name): DENNIS MARTIN FLYNN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FORT MEADE MD
20755-7081
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-7081
US

V. Phone/Fax

Practice location:
  • Phone: 301-667-8895
  • Fax:
Mailing address:
  • Phone: 301-677-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR246891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: