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General NPI Number Information
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NPI Number | 1235309188
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Entity Type | Organization
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Legal Business Name | PARACLETE CARE INC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 10801 HICKORY RIDGE RD SUITE 215
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City | COLUMBIA
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State | MD
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Zip | 21044-3869
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Country | US
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Telephone | 410-740-4411
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Fax | 410-740-4421
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Provider Business Mailing Address
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Address Line | 8600 VINTAGE EARTH PATH
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City | LAUREL
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State | MD
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Zip | 20723-5879
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Country | US
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Telephone | 301-483-0615
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Fax | 240-280-7118
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Authorized Official
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Title or Position | PHYSICIAN
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Name | IKECHUKWU D MBONU
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Credential | MD
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Telephone | 410-740-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0059649
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License Number State | MD
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