| NPI | 1326172248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY L HAYNES Billing Agent Ofc Mgr 410-263-6638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0003077) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |