Provider Demographics
NPI:1013706456
Name:DAWAMED LLC
Entity type:Organization
Organization Name:DAWAMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-645-0254
Mailing Address - Street 1:4611 SOUTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2245
Mailing Address - Country:US
Mailing Address - Phone:531-200-7379
Mailing Address - Fax:
Practice Address - Street 1:8117 HARFORD RD # 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-5792
Practice Address - Country:US
Practice Address - Phone:531-200-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty