Provider record
- NPI
- 1790069490
- Entity type
- Individual
- Sole proprietor
- N
Practice location
- City
- ELLICOTT CITY
- State
- MD
- ZIP
- 210423600
- Country
- US
Taxonomy and license
| Taxonomy code | Primary | License number | License state | Group |
|---|---|---|---|---|
| 363LF0000X | Y | R169531 | MD | not on file |
OIG exclusions
On the OIG exclusion list dated 2026-09-10: 1128b4, excluded 2026-09-20, reinstated no reinstatement on file.
Exclusion check
Excluded on the list dated 2026-09-10.
This is a read of the published NPPES and OIG LEIE files as of the dates shown, not a credentialing decision. Absence from the list we hold is not proof that no exclusion exists. Confirm with the OIG online search.
Provenance
Read from the NPPES data dissemination file (CMS) published 2026-09-14 and the OIG LEIE exclusions file published 2026-09-10.
NPPES
Dispute rail
- Adjudicator
- The provider's own record in NPPES (National Plan and Provider Enumeration System), maintained by CMS. There is no appeal body: a provider corrects the record directly, or authorizes an employer or other trusted organization to do so.
- Informal first step
- Sign in to the NPPES web site and edit the record online. A paper application form is also available for download.
- Window
- A covered health care provider must report any change to the information on file within 30 days of the change. There is no other filing deadline: the record can be corrected at any time.
- Evidence rule
- The online application at the NPPES web site, or the downloadable paper form. No separate evidentiary submission is described.
- Fee
- No fee is stated for obtaining or updating an NPI.
Sources
OIG LEIE
Dispute rail
- Adjudicator
- HHS Office of Inspector General decides reinstatement. Reinstatement of an excluded individual or entity is not automatic once the specified period of exclusion ends.
- Window
- If there is a defined period of exclusion, the excluded individual or entity may begin the process of reinstatement 90 days before the end of that period. A request received earlier than 90 days before the end of the period of exclusion will not be considered.
- Evidence rule
- A written request giving the individual's or entity's full name (and any name used at the time of exclusion), date of birth for an individual, telephone number, email address and mailing address, emailed to reinstatements@oig.hhs.gov or mailed to the Exclusions Branch.
- Fee
- No fee is stated for a reinstatement application.
Sources