Healthcare Provider Details

I. General information

NPI: 1205728037
Provider Name (Legal Business Name): JANET MEJIAS LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MANCHESTER RD STE B
MANCHESTER MD
21102-1850
US

IV. Provider business mailing address

3000 MANCHESTER RD STE B
MANCHESTER MD
21102-1850
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-0066
  • Fax: 410-348-7865
Mailing address:
  • Phone: 410-861-0066
  • Fax: 410-348-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP15892
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: