Healthcare Provider Details

I. General information

NPI: 1144146069
Provider Name (Legal Business Name): AMPAT RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 DELAWARE AVE
GLEN BURNIE MD
21061-3013
US

IV. Provider business mailing address

115 DELAWARE AVE
GLEN BURNIE MD
21061-3013
US

V. Phone/Fax

Practice location:
  • Phone: 240-605-2479
  • Fax: 301-272-1056
Mailing address:
  • Phone: 240-605-2479
  • Fax: 301-272-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN UMEUGO
Title or Position: OWNER
Credential: PHMNP
Phone: 240-605-2479