Premier Medical Group of Maryland LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PREMIER MEDICAL GROUP OF MARYLAND LLC

Practice address

10705 Charter Dr Ste 350
Columbia, MD 21044-2995

Phone

(410) 709-7432

NPI assigned

Aug 9, 2023

Last updated

Sep 23, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Fakorede, MDNPI 1922569714

Title

MD

Phone

(410) 709-7432

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Tax ID family

Premier Medical Group of Maryland2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Premier Medical Group of Maryland LLC

  • Primary Care Clinic/Center
  • Catonsville, MD
  • NPI 1972368587
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Olubunmi Fakorede, MD

  • Family Medicine Physician
  • Washington, DC
  • NPI 1922569714

  MD

  Medicare reassignment NPD Authorized official
• Gebreye W Rufael, MD

  • Internal Medicine Physician
  • Columbia, MD
  • NPI 1659317048
  NPD (past)

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1023791605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10705 CHARTER DR STE 350",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442995",
            "telephone_number": "410-709-7432",
            "fax_number": "410-862-2592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10705 CHARTER DR STE 350",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442995",
            "telephone_number": "410-709-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-09",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "FAKOREDE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "410-709-7432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Precise Mobility Services LLC
• Valerie Jean Preisinger, RN, MS, MBA
• Premier Action Therapy Inc.
• Premier Health Express and Advanced Diagnostics Inc
• Premier Internal Medicine LLC
• Premier Vitality IV and Wellness Center
• Angela Renee Preschel, LCSW-C
• Susan Presler, R.N
• Bridgette Pressley
• Prestige Plastic Surgery, LLC

• Primary Care Clinic/Center in Columbia, MD
• Providers in Columbia, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.