Provider Demographics
NPI:1770265365
Name:PATRIOT PSYCHIATRIC AND ALLIED HEALTH SERVICES
Entity type:Organization
Organization Name:PATRIOT PSYCHIATRIC AND ALLIED HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:UZEGBULEM
Authorized Official - Last Name:EZEDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-916-4825
Mailing Address - Street 1:309 JOPPA CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3742
Mailing Address - Country:US
Mailing Address - Phone:410-916-4825
Mailing Address - Fax:
Practice Address - Street 1:309 JOPPA CROSSING WAY
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3742
Practice Address - Country:US
Practice Address - Phone:410-916-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty