| NPI | 1023824463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREDENTIALING SPECIALIST Credentialing Specialist 410-571-8733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2025-11-13 |