MR. MITCHELL GRAY ODOM (NPI# 1699909283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699909283 |
| Entity Type | Individual |
| Full Name | MR. MITCHELL GRAY ODOM |
| Credential | NP |
| Practice Address |
2001 Medical Pkwy Annapolis MD 21401-3773 |
| Practice Telephone | 4434811000 |
| Practice Fax Number | 4434816515 |
| Mailing Telephone | 4434811000 |
| Mailing Fax Number | 4434816515 |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2017-03-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 5004355 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AC001965 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831570662 | Mitchell Odom | Emergency Medicine | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2015-06-17 |
| Street Address |
2001 MEDICAL PKWY |
| City | ANNAPOLIS |
| State | MD |
| Zip Code | 21401-3773 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548269343 | Karl Derivas Holschuh | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2001 Medical Pkwy, 2nd Floor Donner Pavilion, Annapolis, MD 21401-3280 | 2005-07-14 |
| 1821698952 | Courtney Erin Lamb | Nurse Practitioner | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-10-28 |
| 1013537406 | Heather Zack | General Acute Care Hospital | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-26 |
| 1649890484 | Rebecca Scarlett Allen | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-22 |
| 1003435157 | Caroline Elizabeth Thomas | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-09 |
| 1275162604 | Nirmala Kammar Manjappachar | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-07 |
| 1144859505 | Sabina Nasirova | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-07 |
| 1528697976 | Ebenezer O. Oloyede | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-07 |
| 1699304253 | Elnaz Ebrahimihoor | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-06 |
| 1770112641 | Jessica Urania Reyes-peterson | Student in an Organized Health Care Education/Training Program | 2001 Medical Pkwy, Annapolis, MD 21401-3773 | 2020-04-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497377154 | Michael Khorsandi | Student in an Organized Health Care Education/Training Program | 2001 Medical Parkway, Clatanoff Pavillon, Gmw Office, Annapolis, MD 21401 | 2020-05-15 |
| 1275172033 | Katrice N Nelson | Massage Therapist | Wellsview Cottage Center, 613 Ridgely Avenue, Annapolis, MD 21401 | 2019-12-27 |
| 1548803521 | Victoria Reimnitz | Behavioral Analyst | 2028 Indusrtrial Dr, Ste B&c, Annapolis, MD 21401 | 2019-10-23 |
| 1700438140 | Emily Megan Burke | Nurse Practitioner | 200 Forbes St Annapolis, Md 21401, Suite 200, Annapolis, MD 21401 | 2019-07-16 |
| 1316504848 | Sherina Maryam Shamsa | Counselor | 1830 Forest Drive, Suite H-2, Annapolis, MD 21401 | 2019-05-21 |
| 1497225288 | Jerilyn Deitch | Speech-Language Pathologist | Anne Arundel County Public Schools, 2644 Riva Rd, Annapolis, MD 21401 | 2018-12-05 |
| 1487124038 | Lucinda W Mimms | Speech-Language Pathologist | 2644 Riva Rd., Annapolis, MD 21401 | 2018-11-27 |
| 1487145496 | Michelle Baudean | Behavior Technician | 1919 West St Ste 201, Annapolis, MD 21401 | 2018-05-24 |
| 1730678954 | Stephanie Ruth Streb | Registered Nurse | 130 Admiral Cochrane Dr Ste 103, Annapolis, MD 21401 | 2018-05-02 |
| 1780183947 | Annapolis Sleep Center LLC | Clinic/Center | 2451 Riva Rd, Annapolis, MD 21401 | 2018-02-02 |
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| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255994802 | Grace Doh | Nurse Practitioner | 1831 Forest Dr Ste A, Annapolis, MD 21401-4430 | 2019-04-18 |
| 1659688141 | Robert Allen-emerson | Nurse Practitioner | 175 Admiral Cochrane Dr Ste 110, Annapolis, MD 21401-8445 | 2010-09-07 |
| 1790276988 | James Perritt | Nurse Practitioner | 175 Admiral Cochrane Dr Ste 110, Annapolis, MD 21401 | 2018-05-23 |
| 1427320100 | Jennifer L Wilhelm | Nurse Practitioner | 2635 Riva Rd, Annapolis, MD 21401-7430 | 2012-01-27 |
| 1285941641 | Victoria Kennedy Tyson | Nurse Practitioner | 175 Admiral Cochrane Dr Ste 110, Annapolis, MD 21401 | 2010-09-08 |
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| 1750989042 | Osereme Nora Agboifo | Nurse Practitioner | 200 Ejoppa Rd Suite 106, Townson, MD 21286 | 2020-10-09 |
| 1639776446 | Serenity Heart Healthcare, LLC | Nurse Practitioner | 6755 Business Pkwy Ste 304, Elkridge, MD 21075-6740 | 2020-10-05 |
| 1689281529 | Premier Psychiatry, LLC | Nurse Practitioner | 10601 Virginia Ave, Cockeysville, MD 21030-2315 | 2020-09-24 |
| 1407462559 | Mem Scepter Home & Behavioral | Nurse Practitioner | 14104 Dawn Whistle Way, Bowie, MD 20721-1304 | 2020-09-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.