Healthcare Provider Details

I. General information

NPI: 1952818999
Provider Name (Legal Business Name): OPTIMIZE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 BEDFORD AVE STE 113
PIKESVILLE MD
21208-3737
US

IV. Provider business mailing address

PO BOX 72098
ROSEDALE MD
21237-8098
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-7101
  • Fax: 443-868-7956
Mailing address:
  • Phone: 443-868-7101
  • Fax: 443-868-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR179125
License Number StateMD

VIII. Authorized Official

Name: JOHN KAMAU NGUGI
Title or Position: OWNER/SOLE MEMBER
Credential: CRNP-C
Phone: 443-248-1929