Provider Demographics
NPI:1790114379
Name:NAVA MARYLAND, LLC
Entity Type:Organization
Organization Name:NAVA MARYLAND, LLC
Other - Org Name:NAVA HEALTH AND VITALITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:E.V.P.
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-910-2827
Mailing Address - Street 1:9755 PATUXENT WOODS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8880 MCGAW RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:800-762-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty