Organization
MEDHAVEN HEALTH LLC
Active
Other names
MedHaven LLC
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWAKEMI F BALOGUN (CRNP)
(240) 515-6550
Entity
Organization
Contact information
Practice address
7310 RITCHIE HWY STE 519, GLEN BURNIE, MD 21061-3099
(240) 515-6550
Mailing address
7310 RITCHIE HWY STE 519, GLEN BURNIE, MD 21061-3099
(240) 515-6550
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962963389
—
MD
Enumeration date
06/17/2022
Last updated
11/27/2023
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