| NPI | 1104663970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN HEITHAUS CFO 410-535-8236 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 207QB0002X Family Medicine, Bariatric Medicine | |
| 207RB0002X Internal Medicine, Bariatric Medicine | |
| 208600000X Surgery | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2024-07-10 |