Healthcare Provider Details

I. General information

NPI: 1275913881
Provider Name (Legal Business Name): AGAPE HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 WHITEHEAD RD
WOODLAWN MD
21207-4003
US

IV. Provider business mailing address

1726 WHITEHEAD RD
WOODLAWN MD
21207-4003
US

V. Phone/Fax

Practice location:
  • Phone: 410-362-1600
  • Fax:
Mailing address:
  • Phone: 410-362-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: AMANDA GORMAN
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 410-362-1600