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General NPI Number Information
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NPI Number | 1649847724
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL GROUP
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 6018 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-1400
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Country | US
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Telephone | 443-985-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 6018 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-1400
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Country | US
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Telephone | 443-985-6011
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BLESSING GABRIEL
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Credential | CRNP
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Telephone | 443-985-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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