Provider Demographics
NPI:1467159004
Name:ST. MARY'S MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ADEKEYE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, PMHNP-BC
Authorized Official - Phone:240-547-8986
Mailing Address - Street 1:4701 TRIPPER LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6038
Mailing Address - Country:US
Mailing Address - Phone:240-547-8986
Mailing Address - Fax:
Practice Address - Street 1:4701 TRIPPER LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6038
Practice Address - Country:US
Practice Address - Phone:240-547-8986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty