| NPI | 1174387286 |
|---|---|
| Other Name | PRESTIGE PRACTICE MANAGEMENT & IT SERVICES |
| Other Name | AUTUMN LAKE LOCH RAVEN SMG LLC |
| Entity Type | Organization |
| Authorized Contact | KRYSTLE BROWN Billing Manager 410-870-9380 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-02-08 |