Individual
MR. MITCHELL GRAY ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2001 MEDICAL PKWY, ANNAPOLIS, MD 21401-3773
(443) 481-1000
(443) 481-6515
Mailing address
2001 MEDICAL PKWY, ANNAPOLIS, MD 21401-3773
(443) 481-1000
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5004355
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AC001965
MD
Other
Enumeration date
05/11/2009
Last updated
03/09/2017
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