PARKVILLE MEDICAL GROUP LLC (NPI# 1962960229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962960229 |
| Entity Type | Organization |
| Organization Name | PARKVILLE MEDICAL GROUP LLC |
| Practice Address |
1721 Belfast Rd Sparks MD 21152-9786 |
| Practice Telephone | 4103713373 |
| Mailing Telephone | 4103713373 |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2019-03-06 |
| Authorized Official Name | MS. TERRY LYNN STEVENSON (MANAGING MEMBER/PROVIDER) |
| Authorized Official Telephone | 4103713373 |
| Authorized Official Credential | CRNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 605M957F | 05 | |
| DEA | MS0440432 | 01 |
| Street Address |
1721 BELFAST RD |
| City | SPARKS |
| State | MD |
| Zip Code | 21152-9786 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942554837 | Tridentusa Mobile Clinical Services, LLC | Nurse Practitioner | 930 Ridgebrook Rd Fl 3, Sparks, MD 21152 | 2012-10-31 |
| 1528321635 | Caitlin Lee Sprouse | Occupational Therapist | 14550a York Road, Sparks, MD 21152 | 2012-06-22 |
| 1184954679 | Suzanne Heid Geisbert | Behavioral Analyst | 14550 York Rd, Sparks, MD 21152 | 2010-01-05 |
| 1790850519 | Joan Li Wang | Obstetrics & Gynecology | 913 Ridgebrook Road, Suite 314, Sparks, MD 21152 | 2006-11-21 |
| 1346331410 | Rosemaria K Kariampuzha | Pharmacist | 112 Hunt Creek Lane, Sparks, MD 21152 | 2006-09-27 |
| 1982649810 | Matthew Joseph Lepito | Chiropractor | 10 Fila Way, Suite 208, Sparks, MD 21152 | 2006-06-17 |
| 1467415984 | Bionicare Medical Technologies Inc | Durable Medical Equipment & Medical Supplies | 53 Loveton Circle, Sparks, MD 21152 | 2006-04-07 |
| 1093797839 | Aubrey Richardson | Psychiatry & Neurology | 164 English Run Cir, Sparks, MD 21152 | 2005-11-17 |
| 1184110710 | Alexis Crystal Cruz | Behavior Technician | 14550 York Rd, Sparks, MD 21152 | 2018-07-06 |
| 1346670619 | Alicia C. Kilpatrick | Physician Assistant | 10 Fila Way, Suite 205, Sparks, MD 21152 | 2013-11-22 |
| Find all providers in zip 21152 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386245371 | Cynthia Tessie | Family Medicine | 1398 Hawthorn Dr, Hanover, MD 21076-2197 | 2020-11-05 |
| 1093354920 | Irina Konstantinovna Baum | Family Medicine | 3893 Fortress Ct, Hampstead, MD 21074-1790 | 2019-12-23 |
| 1972140242 | Abisola Omowumi Alade | Family Medicine | 9312 Silver Charm Dr, Randallstown, MD 21133-4610 | 2019-12-05 |
| 1336799634 | Abosede Adeniji Sakariyah | Family Medicine | 18403 Woodhouse Ln, Germantown, MD 20874-4110 | 2019-09-18 |
| 1548665771 | Robert Charles Frey | Family Medicine | 801 Richardson Dr, Harwood, MD 20776-9463 | 2014-10-30 |
| 1639571573 | C. Gottfried Baumann | Family Medicine | 8293 Brices Mill Rd, Chestertown, MD 21620-4678 | 2014-09-23 |
| 1184067514 | Vijaya Lakshmi Alla | Family Medicine | 6014 Old Branch Avenue, Temple Hills, MD 20748 | 2013-04-16 |
| 1750623393 | William Nicholas Fishbein | Family Medicine | 13549 Scottish Autumn Ln, Gaithersburg, MD 20878-3990 | 2013-03-21 |
| 1114273844 | Kum Hai Lee | Family Medicine | 815 Woodley Dr, Rockville, MD 20850-2033 | 2012-07-31 |
| 1366726358 | Narciso A De Borja | Family Medicine | 6615 Reisterstown Rd Fl 1, Baltimore, MD 21215-2686 | 2011-10-07 |
| Find all providers with the same taxonomy | ||||
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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.