Organization
GENNESARET MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOYIN OPESANMI M.D (PHYSICIAN)
(410) 963-5870
Entity
Organization
Contact information
Practice address
13992 BALTIMORE AVE STE 200, LAUREL, MD 20707-5010
(410) 528-6003
(410) 528-6004
Mailing address
12108 EARLY LILACS PATH, CLARKSVILLE, MD 21029-1676
(410) 963-5870
(410) 528-6004
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D0059876
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000911300
—
MD
Enumeration date
03/04/2011
Last updated
05/17/2019
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