MEDICARE: MY FATHERS PLAN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1033843230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY FATHERS PLAN INC

Provider Business Mailing Address
First Line	:	4017 OLD YORK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-1287
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 W 40TH ST STE 319
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-2109
Country	:	US
Telephone Number	:	443-869-7675
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAWOOD THOMAS
Credential	:
Telephone Number	:	443-869-7675

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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