Maryland Specialty Group LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

MARYLAND SPECIALTY GROUP LLC

Practice address

12200 Annapolis Rd
Ste 123
Glenn Dale, MD 20769-9182

Phone

(301) 552-9495

Fax

(301) 552-9743

NPI assigned

May 8, 2013

Organization subpart

No

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

Authorized official

Name

Naomi Nwagwe

Title

Billing Manager

Phone

(301) 552-9495

Specialties & licenses 2

Addresses

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

  • Obstetrics & Gynecology Physician
  • Glenn Dale, MD
  • NPI 1023157781

  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

  DC

  Medicare reassignment
• 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": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1114362845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2056",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207182056",
            "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": "STE 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": "2013-05-08",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "NWAGWE",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "301-552-9495"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ULTIMA CARE LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• 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
• Florence Mbah

• Vascular Surgery Physician in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Vascular Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.