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

516 N Rolling Rd Ste 108
Catonsville, MD 21228-4141

Phone

(410) 709-7432

NPI assigned

Feb 14, 2024

Organization subpart

No

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

Authorized official

Name

Mary Olubunmi FakoredeNPI 1922569714

Title

MD

Phone

(410) 709-7432

Specialties & licenses 1

Addresses

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
  • Columbia, MD
  • NPI 1023791605
  NPD tax ID

Locations

Practitioners 1

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

• Mary Olubunmi Fakorede, MD

  • Addiction Medicine (Family Medicine) Physician
  • Baltimore, MD
  • NPI 1922569714
  NPD Authorized official

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

{
    "created_epoch": "1707868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1972368587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 N ROLLING RD STE 108",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212284141",
            "telephone_number": "410-709-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 N ROLLING RD STE 108",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212284141",
            "telephone_number": "410-709-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-14",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "FAKOREDE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "OLUBUNMI",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "410-709-7432"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morris Brian Polsky, M.D.
• Michael Potter
• Scott Craig Poulton, M.D.
• Shanta Pearl Henderson Powell, MD
• Precision Healthcare Resources Inc
• Premier Pain Management
• Charles August Priller Jr., D.S.S.
• Prince George'S County Health Department
• Privia Medical Group, LLC
• Privia Medical Group, LLC

• Primary Care Clinic/Center in Catonsville, MD
• Providers in Catonsville, 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 Feb 14, 2024; 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.