Healthcare Provider Details

I. General information

NPI: 1356255665
Provider Name (Legal Business Name): BRIGHTPATH HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 MILESTONE CENTER DR STE 600
GERMANTOWN MD
20876-7102
US

IV. Provider business mailing address

12410 MILESTONE CENTER DR STE 600
GERMANTOWN MD
20876-7102
US

V. Phone/Fax

Practice location:
  • Phone: 240-881-3733
  • Fax:
Mailing address:
  • Phone: 240-881-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELEANOR DZODZOMENYO
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 240-881-3733