NPIMap

Organization Active NPI

Dynmed Primary Care and Wellness P. a

  • Psychiatric/Mental Health Nurse Practitioner
  • Riverdale, MD
National Provider Identifier
1407528862
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DYNMED PRIMARY CARE AND WELLNESS P. A
Practice address
6510 Kenilworth Ave Ste 2700
Riverdale, MD 20737-1353
Phone
(301) 526-1004
NPI assigned
Oct 4, 2021
Organization subpart
Yes
Parent organization
DYNMED PRIMARY CARE AND WELLNESS P. AAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Authorized official

Name
Mrs. Ekop Graham, NPNPI 1871041764
Title
Director
Phone
(301) 526-1004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

6510 Kenilworth Ave Ste 2700
Riverdale, MD 20737-1353

Mailing address

6510 Kenilworth Ave Ste 2700
Riverdale, MD 20737-1353
Phone (301) 526-1004

National Provider Directory

National Provider Directory
Tax ID family
Dynmed Primary Care and Wellness PA2 organizations share this tax ID, including this one
Part of
Dynmed Primary Care and Wellness PA

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1407528862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6510 KENILWORTH AVE STE 2700",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371353",
            "telephone_number": "301-526-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6510 KENILWORTH AVE STE 2700",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371353",
            "telephone_number": "301-526-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNMED PRIMARY CARE AND WELLNESS P. A",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DYNMED PRIMARY CARE AND WELLNESS P. A",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "EKOP",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "301-526-1004",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.