Provider Demographics
NPI:1548708266
Name:EG FAMILY PRACTICE AND PSYCHIATRY SERVICES INC
Entity type:Organization
Organization Name:EG FAMILY PRACTICE AND PSYCHIATRY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:O
Authorized Official - Last Name:AKINPETIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD DR OF NURSING
Authorized Official - Phone:301-367-0564
Mailing Address - Street 1:PO BOX 4153
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20775-0153
Mailing Address - Country:US
Mailing Address - Phone:301-367-0564
Mailing Address - Fax:301-333-1909
Practice Address - Street 1:11028 SPRING LAKE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2924
Practice Address - Country:US
Practice Address - Phone:301-367-0564
Practice Address - Fax:301-333-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 261QE0002X
MD364SF0001X, 364SP0810X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute CareGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD234115ZQQYMedicare PIN