Provider Demographics
NPI:1598203812
Name:MERCY IJOMA-FAMILY HEALTH CONNECTIONS
Entity Type:Organization
Organization Name:MERCY IJOMA-FAMILY HEALTH CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:IJOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-280-2407
Mailing Address - Street 1:6281 LOVEKNOT PLACE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9055 CHEVROLET DRIVE
Practice Address - Street 2:STE 205
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-465-5451
Practice Address - Fax:240-713-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
MDR132023261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care