Provider Demographics
NPI:1922664739
Name:CENTRAL MARYLAND PSYCHIATRIC CARE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CENTRAL MARYLAND PSYCHIATRIC CARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNMEFUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:667-300-8884
Mailing Address - Street 1:6030 DAYBREAK CIR STE A150-121
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:667-300-8884
Mailing Address - Fax:
Practice Address - Street 1:2444 SOLOMONS ISLAND RD STE 205
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3719
Practice Address - Country:US
Practice Address - Phone:667-300-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty