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General NPI Number Information
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NPI Number | 1861071912
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Entity Type | Organization
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Legal Business Name | MILLENNIUM 25 GROUP LLC
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 672 OLD MILL RD STE I
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1363
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Country | US
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Telephone | 410-729-0630
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Fax | 410-729-0091
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Provider Business Mailing Address
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Address Line | 8775 CENTRE PARK DR STE 251
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City | COLUMBIA
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State | MD
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Zip | 21045-2177
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Country | US
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Telephone | 917-873-5716
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Fax | 410-729-0091
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRAVIS ALDEN BAIRD
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Credential | CRNP
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Telephone | 917-873-5716
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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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