# REDICARE MOBILE HEALTH SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427697556
- **Authorized official:** MRS. ASHLEY BROTHERS TOLLIVER PA-C (CEO/PHYSICIAN ASSISTANT)
- **Authorized official phone:** (240) 743-8520

## Contact information

- **Practice address:** 12410 MILESTONE CENTER DR STE 600, GERMANTOWN, MD 20876-7102
- **Practice address phone:** (240) 743-8520
- **Mailing address:** 12410 MILESTONE CENTER DR STE 600, GERMANTOWN, MD 20876-7102
- **Mailing address phone:** (301) 307-5335
- **Mailing address fax:** (667) 256-7022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/07/2020
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0010-10529 | NC PHYSICIAN ASSISTANT LICENSE | NC |
| 01 | — | 0110007406 | VA PHYSICIAN ASSISTANT LICENSE | VA |
| 01 | — | C05839 | MARYLAND PHYSICIAN ASSISTANT LICENSE | MD |
| 01 | — | PA031239 | DISTRICT OF COLUMBIA PHYSICIAN ASSISTANT LICENSE | DC |
| 01 | — | PA86989 | MD CDS | MD |