Maryland Specialty Group LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

D0040683 Issued in MD

Legal business name

MARYLAND SPECIALTY GROUP LLC

Practice address

12200 Annapolis Rd
Suite# 123
Glenn Dale, MD 20769-9182

Phone

(301) 552-9495

Fax

(301) 552-9743

NPI assigned

Feb 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Naomi A Nwagwe

Title

Billing/Business Manager

Phone

(301) 552-9495

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• ULTIMA CARE LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Maryland Specialty Group LLC

  • Vascular Surgery Physician
  • Glenn Dale, MD
  • NPI 1114362845

  O20130605000617

  Same enrollment

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kwasi A Debra, MD

  • Gynecology Physician
  • Glenn Dale, MD
  • NPI 1972512408

  Obstetrics & Gynecology

  NPD
• Kimberly L Bolling, M.D

  • Internal Medicine Physician
  • Bowie, MD
  • NPI 1255363891
  NPD (past)
• Emmanuel P Brown, M.D.

  • Internal Medicine Physician
  • Temple Hills, MD
  • NPI 1841397601
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1023157781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "SUITE# 123",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-552-9495",
            "fax_number": "301-552-9743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "SUITE# 123",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-552-9495",
            "fax_number": "301-552-9743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND SPECIALTY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "NWAGWE",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING/BUSINESS MANAGER",
        "authorized_official_telephone_number": "301-552-9495",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0040683",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MD",
            "license": "D0040683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "G01686",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ULTIMA CARE LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Marika L Martin
• Mary Tabi
• Maryland Children Health Center
• Maryland Family Healthcare, LLC
• Maryland Specialty Care, LLC
• Maryland Specialty Group LLC
• Kier Maxwell, PHD, LCMFT
• Ashley Mbah
• Carlson Fon Mbah
• Chantale Mbah

• Obstetrics & Gynecology Physician in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Obstetrics & Gynecology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.