PORT RECOVERY PHYSICIANS CARE LLC (NPI# 1124470356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124470356 |
| Entity Type | Organization |
| Organization Name | PORT RECOVERY PHYSICIANS CARE LLC |
| Practice Address |
8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 |
| Practice Telephone | 4438694909 |
| Practice Fax Number | 4438694928 |
| Mailing Telephone | 4435348735 |
| Mailing Fax Number | 4105348737 |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2018-11-15 |
| Authorized Official Name | JOANNE GRANRUTH (OWNER) |
| Authorized Official Telephone | 4105348735 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | CAREFIRST BLUECROSS BLUESHEILD | CP64-0000 | 01 |
| MD | 886200100 | 05 |
| Street Address |
8615 RIDGELYS CHOICE DR STE 205 |
| City | NOTTINGHAM |
| State | MD |
| Zip Code | 21236-3028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366876690 | Carol Garey | Social Worker | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2013-08-22 |
| 1649733858 | Port Recovery Iop Inc. | Clinical Medical Laboratory | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2019-04-14 |
| 1578026464 | Port Recovery Iop Inc. | Counselor | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2019-04-09 |
| 1528522901 | Port Recovery Iop Inc. | Clinic/Center | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2019-01-30 |
| 1902375090 | Port Recovery Mental Health, Inc. | Counselor | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2018-11-19 |
| 1598234601 | Port Recovery Iop Inc. | Counselor | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2018-11-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699381467 | Monique Gaston | Counselor | Well Life Counseling and Consulting, 9649 Belair Road, Ste. 104, Nottingham, MD 21236 | 2020-09-17 |
| 1215575519 | Bh Brightview Perry Hall Opco, LLC | Alzheimer Center (Dementia Center) | 9657 Belair Road, Nottingham, MD 21236 | 2019-12-17 |
| 1750929493 | Bh Brightview White Marsh Opco, LLC | Alzheimer Center (Dementia Center) | 8100 Rossville Blvd., Baltimore, MD 21236 | 2019-12-12 |
| 1083257646 | Matthew Peter Halstad | Behavioral Analyst | 8090 Sandpiper Circle, Nottingham, MD 21236 | 2019-10-25 |
| 1609331602 | Tunisia Buise | Social Worker | 4132 E. Joppa Road Ste. 110-#1248, Baltimore, MD 21236 | 2019-02-04 |
| 1730673047 | Golden Jemz Adult Medical Day | Clinic/Center | 5020 Cambell Blvd, Nottingham, MD 21236 | 2018-06-20 |
| 1487143400 | For Eyes Optical of Pa | Eyewear Supplier (Equipment, not the service) | 7984 Honeygo Blvd, Nottingham, MD 21236 | 2018-05-04 |
| 1619478922 | Weis Markets, Inc. | Pharmacy | 7927 Belair Rd Ste S, Nottingham, MD 21236 | 2018-02-22 |
| 1285133918 | Joan Rosa Keller | Behavior Technician | 3501 Taylor Ave., Baltimore, MD 21236 | 2018-02-08 |
| 1205341146 | Ebony Watkins | Nurse Practitioner | 8940 Kilkenny Circle, Nottingham, MD 21236 | 2017-12-13 |
| Find all providers in zip 21236 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346304490 | Fernando Alfonso Delgado | Internal Medicine | 41 Locust Path Ct, Nottingham, MD 21236-5548 | 2006-12-21 |
| 1952334112 | Lorraine Beatrice Ofori-awuah | Internal Medicine | 5430 Campbell Blvd., Suite 214, Nottingham, MD 21236 | 2006-07-09 |
| 1962451179 | Sofia M Suriel | Internal Medicine | 8870 Belair Rd, Nottingham, MD 21236-2401 | 2006-05-08 |
| 1952732430 | Maryland Healthcare PC | Internal Medicine | 4155 Glen Park Rd, Nottingham, MD 21236-1019 | 2013-12-09 |
| 1336408160 | Ethel Mojoko | Internal Medicine | 4924 Campbell Blvd, #200, Nottingham, MD 21236-5908 | 2012-05-14 |
| 1497975809 | Kelly Wei Wei Koay | Internal Medicine | 4924 Campbell Blvd, Suite 200, Nottingham, MD 21236-5908 | 2007-04-26 |
| 1073644324 | Marcea Burnette Whitaker | Internal Medicine | 4920 Campbell Blvd, Kaiser Permanente White Marsh Medical Center, Nottingham, MD 21236-5916 | 2007-03-08 |
| 1497805147 | Jasmin Hans | Internal Medicine | 4920 Campbell Blvd, Nottingham, MD 21236-5916 | 2007-01-12 |
| 1366526980 | David Madder | Internal Medicine | 4924 Campbell Blvd, Suite 200, Nottingham, MD 21236-5908 | 2006-10-24 |
| 1316048218 | Sharon P Dlhosh | Internal Medicine | 4924 Campbell Blvd, Suite 200, Nottingham, MD 21236 | 2006-09-26 |
| Find all providers in NOTTINGHAM | ||||
| City | NOTTINGHAM |
| Zip Code | 21236 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.