Healthcare Provider Details

I. General information

NPI: 1528450905
Provider Name (Legal Business Name): REGINALD AMADI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 REISTERSTOWN RD STE 218
PIKESVILLE MD
21208-4325
US

IV. Provider business mailing address

1517 REISTERSTOWN RD STE 218
PIKESVILLE MD
21208-4325
US

V. Phone/Fax

Practice location:
  • Phone: 443-627-0449
  • Fax:
Mailing address:
  • Phone: 443-627-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberR3664
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR3664
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR3664
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: