Healthcare Provider Details

I. General information

NPI: 1558288324
Provider Name (Legal Business Name): IRENE MBUH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BRANCH AVE STE 403
TEMPLE HILLS MD
20748-1251
US

IV. Provider business mailing address

3611 BRANCH AVE STE 403
TEMPLE HILLS MD
20748-1251
US

V. Phone/Fax

Practice location:
  • Phone: 301-909-0123
  • Fax: 301-909-0050
Mailing address:
  • Phone: 301-909-0123
  • Fax: 301-909-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR236141
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR236141
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: