MEDICARE: DORIS AKUDAZIE BEN NP-BC

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	R167482	MD
2	251S00000X	Community/Behavioral Health Agency	R167482	MD
3	363LF0000X	Family Nurse Practitioner	R167482	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1417510967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS AKUDAZIE BEN NP-BC

Provider Business Mailing Address
First Line	:	5721 RITCHIE HWY
Second Line	:
City	:	BROOKLYN
State	:	MD
Zip	:	21225-3640
Country	:	US
Telephone Number	:	410-206-3839
Fax Number	:	410-401-0102

Provider Business Practice Location Address
First Line	:	5721 RITCHIE HWY
Second Line	:
City	:	BROOKLYN
State	:	MD
Zip	:	21225-3640
Country	:	US
Telephone Number	:	585-415-1942
Fax Number	:	410-401-0102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	04/22/2026

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