MEDICARE: EVIDENCE SUPPORT SERVICES

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
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1538953328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVIDENCE SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	2410 SUSAN HODGES PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-8945
Country	:	US
Telephone Number	:	240-716-4638
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 LAKE FOREST DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-8983
Country	:	US
Telephone Number	:	240-716-4638
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. FRITZ EBULOH
Credential	:
Telephone Number	:	240-716-4638

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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Directions to “EVIDENCE SUPPORT SERVICES ” Practice Location

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