Provider Demographics
NPI:1851938534
Name:TRIUMPH PRIMARY CARE LLC
Entity Type:Organization
Organization Name:TRIUMPH PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:IKECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-593-7556
Mailing Address - Street 1:413 PULASKI HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3625
Mailing Address - Country:US
Mailing Address - Phone:410-593-7556
Mailing Address - Fax:410-510-7938
Practice Address - Street 1:413 PULASKI HWY STE 201
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3625
Practice Address - Country:US
Practice Address - Phone:410-593-7556
Practice Address - Fax:410-510-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care