| NPI | 1053020412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY RENNA THOMAS Credentialing Specialist 410-661-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2022-11-15 |