| NPI | 1407970601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELENCIO VENTURA Medical Director 410-486-2298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |