Provider Demographics
NPI:1831834969
Name:EVOLVE HEALTH PARTNERS
Entity type:Organization
Organization Name:EVOLVE HEALTH PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-548-3733
Mailing Address - Street 1:2528 MOUNTAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7202
Mailing Address - Country:US
Mailing Address - Phone:443-798-7778
Mailing Address - Fax:410-360-1675
Practice Address - Street 1:2528 MOUNTAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7202
Practice Address - Country:US
Practice Address - Phone:443-798-7778
Practice Address - Fax:410-360-1675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLVE HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-03
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD317219800Medicaid