Healthcare Provider Details

I. General information

NPI: 1649102294
Provider Name (Legal Business Name): CHOSEN PEDIATRICS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 RITCHIE HWY
GLEN BURNIE MD
21061-4378
US

IV. Provider business mailing address

7746 RITCHIE HWY
GLEN BURNIE MD
21061-4378
US

V. Phone/Fax

Practice location:
  • Phone: 443-854-8563
  • Fax:
Mailing address:
  • Phone: 443-854-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MOFOLUKE SOBOWALE
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 443-854-8563