MEDICARE: ADDICTION MEDICATION CLINIC LLC

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	363L00000X	Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184208688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION MEDICATION CLINIC LLC

Provider Business Mailing Address
First Line	:	407 MALCOLM DR
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-6107
Country	:	US
Telephone Number	:	410-702-0921
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 MALCOLM DR
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-6107
Country	:	US
Telephone Number	:	410-702-0921
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RACHEL SAGI
Credential	:
Telephone Number	:	410-702-0921

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	01/23/2026

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