Provider Demographics
NPI:1215093786
Name:BAYSIDE BEHAVIORAL HEALTH CLINIC OF
Entity type:Organization
Organization Name:BAYSIDE BEHAVIORAL HEALTH CLINIC OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNMEFUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-292-4559
Mailing Address - Street 1:PO BOX 6250
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-0250
Mailing Address - Country:US
Mailing Address - Phone:410-292-4559
Mailing Address - Fax:
Practice Address - Street 1:2444 SOLOMONS ISLAND RD STE 205
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3723
Practice Address - Country:US
Practice Address - Phone:410-292-4559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty