Provider Demographics
NPI:1740059005
Name:MD BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MD BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:AYOKUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLULEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-756-5092
Mailing Address - Street 1:4000 MITCHELLVILLE RD STE A414
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3142
Mailing Address - Country:US
Mailing Address - Phone:301-249-8100
Mailing Address - Fax:301-390-8086
Practice Address - Street 1:7610 CARROLL AVE STE 360
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6323
Practice Address - Country:US
Practice Address - Phone:301-249-8100
Practice Address - Fax:301-390-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty