Provider Demographics
NPI:1235309188
Name:PARACLETE CARE INC
Entity Type:Organization
Organization Name:PARACLETE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:D
Authorized Official - Last Name:MBONU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-740-4411
Mailing Address - Street 1:8600 VINTAGE EARTH PATH
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5879
Mailing Address - Country:US
Mailing Address - Phone:301-483-0615
Mailing Address - Fax:240-280-7118
Practice Address - Street 1:10801 HICKORY RIDGE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3869
Practice Address - Country:US
Practice Address - Phone:410-740-4411
Practice Address - Fax:410-740-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415713300Medicaid
MD415713300Medicaid
MD623PMedicare PIN
DC137642Medicare PIN