Healthcare Provider Details

I. General information

NPI: 1326826306
Provider Name (Legal Business Name): IPNAM HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 2ND AVE STE 404B
SILVER SPRING MD
20910-3374
US

IV. Provider business mailing address

711 W 40TH STREET STE 153, #150
BALTIMORE MD
21211-2143
US

V. Phone/Fax

Practice location:
  • Phone: 240-653-9343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA A MILLER
Title or Position: OWNER
Credential: MD
Phone: 240-653-9343