Provider Demographics
NPI:1649847724
Name:OPTIMUM MEDICAL GROUP
Entity type:Organization
Organization Name:OPTIMUM MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP - PMH
Authorized Official - Phone:443-985-6011
Mailing Address - Street 1:3211 BELAIR RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1400
Mailing Address - Country:US
Mailing Address - Phone:443-985-6011
Mailing Address - Fax:
Practice Address - Street 1:3211 BELAIR RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1400
Practice Address - Country:US
Practice Address - Phone:443-985-6011
Practice Address - Fax:800-616-5240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUM MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-08
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty