Provider Demographics
NPI:1235861931
Name:SAMORA MTL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SAMORA MTL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-633-1676
Mailing Address - Street 1:14204 WILD WOOD CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8580
Mailing Address - Country:US
Mailing Address - Phone:301-633-1676
Mailing Address - Fax:
Practice Address - Street 1:110 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2693
Practice Address - Country:US
Practice Address - Phone:301-633-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3016331676Medicaid