Healthcare Provider Details

I. General information

NPI: 1427641786
Provider Name (Legal Business Name): ASSURED ACCESS MEDICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 HANOVER PKWY STE C
GREENBELT MD
20770-2022
US

IV. Provider business mailing address

7221 HANOVER PKWY STE C
GREENBELT MD
20770-2022
US

V. Phone/Fax

Practice location:
  • Phone: 301-674-9319
  • Fax: 301-439-0968
Mailing address:
  • Phone: 301-674-9319
  • Fax: 301-439-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: OLUREMI T ILUPEJU
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 301-439-4422