Provider Demographics
NPI:1861071912
Name:MILLENNIUM 25 GROUP LLC
Entity type:Organization
Organization Name:MILLENNIUM 25 GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:917-873-5716
Mailing Address - Street 1:8775 CENTRE PARK DR STE 251
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2177
Mailing Address - Country:US
Mailing Address - Phone:917-873-5716
Mailing Address - Fax:410-729-0091
Practice Address - Street 1:672 OLD MILL RD STE I
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1363
Practice Address - Country:US
Practice Address - Phone:410-729-0630
Practice Address - Fax:410-729-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty