Provider Demographics
NPI:1295342772
Name:GILEAD ASSOCIATES LLC
Entity type:Organization
Organization Name:GILEAD ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GBEMISOLA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOJELOPE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:667-225-0673
Mailing Address - Street 1:206 MULBERRY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7514
Mailing Address - Country:US
Mailing Address - Phone:432-038-0944
Mailing Address - Fax:
Practice Address - Street 1:7661 ARUNDEL MILLS BLVD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1305
Practice Address - Country:US
Practice Address - Phone:672-250-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW20623088OtherMARYLAND DEPARTMENT OF TAXATION-SDAT