| NPI | 1447016035 |
|---|---|
| Other Name | AUTUMN LAKE PACC LTC SMG NEPH |
| Entity Type | Organization |
| Authorized Contact | KRYSTLE BROWN Billing Manager 410-870-9380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-07-23 |