| NPI | 1104968668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA CORNELL Credentailing Coordinator 410-398-4679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0056449) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-08-22 |