Provider Demographics
NPI:1053066936
Name:PINNACLE FAMILY CARE PRACTICE
Entity type:Organization
Organization Name:PINNACLE FAMILY CARE PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADENIKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-527-1497
Mailing Address - Street 1:10220 S DOLFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3660
Mailing Address - Country:US
Mailing Address - Phone:443-912-5077
Mailing Address - Fax:410-835-7865
Practice Address - Street 1:5835 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3612
Practice Address - Country:US
Practice Address - Phone:443-912-5077
Practice Address - Fax:410-835-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD622039800Medicaid
MDR224315OtherFAMILY MEDICINE