Healthcare Provider Details

I. General information

NPI: 1841941119
Provider Name (Legal Business Name): EVOLVE HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 MOUNTAIN RD STE 104
PASADENA MD
21122-7202
US

IV. Provider business mailing address

2528 MOUNTAIN RD STE 204
PASADENA MD
21122-7204
US

V. Phone/Fax

Practice location:
  • Phone: 443-548-3733
  • Fax:
Mailing address:
  • Phone: 443-548-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICK ALBAUGH
Title or Position: DIRECTOR
Credential: CSC-AD
Phone: 301-538-4114