Millennium 25 Group LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MILLENNIUM 25 GROUP LLC

Practice address

672 Old Mill Rd Ste I
Millersville, MD 21108-1363

Phone

(410) 729-0630

Fax

(410) 729-0091

NPI assigned

Apr 6, 2021

Last updated

Apr 15, 2021By 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

Travis Alden Baird, CRNP

Title

President

Phone

(917) 873-5716

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1861071912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8775 CENTRE PARK DR STE 251",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452177",
            "telephone_number": "917-873-5716",
            "fax_number": "410-729-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 OLD MILL RD STE I",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081363",
            "telephone_number": "410-729-0630",
            "fax_number": "410-729-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM 25 GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-06",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "BAIRD",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "ALDEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-873-5716",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.